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The effect of very low birth weight and social risk on neurocognitive abilities at school age
1Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
Insights
Children with very low birth weight (VLBW) show poorer neurocognitive abilities at school age. These differences persist even without major neurologic issues, though social risk is a primary factor.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Very low birth weight (VLBW) is associated with potential long-term developmental challenges.
- Understanding the persistence of neurocognitive deficits and the influence of social factors is crucial for early intervention.
Purpose of the Study:
- To investigate neurocognitive abilities in school-aged children born with VLBW compared to normal birth weight peers.
- To determine if VLBW-associated deficits persist after controlling for neurological impairment and social risk.
- To examine the potential interaction between VLBW and social risk factors on neurocognitive outcomes.
Main Methods:
- A cohort study comparing 249 VLBW children with 363 normal birth weight controls, tested at 8 years of age.
- Comprehensive assessments included neurological examination, intelligence, language, speech, academic, motor, and behavioral tests.
- Statistical analyses, including multiple regression, were used to control for confounding variables like neurological impairment and social risk.
Main Results:
- VLBW children exhibited significantly poorer performance across most neurocognitive domains compared to controls.
- Deficits persisted in VLBW children without major neurological abnormalities, except in social competence, reading, and spelling.
- Even neurologically and intellectually normal VLBW children showed impairments in expressive language, memory, visuomotor skills, fine motor function, and hyperactivity.
Conclusions:
- VLBW is independently associated with poorer neurocognitive outcomes at school age, even in the absence of major neurological impairment.
- Social risk is a significant determinant of outcome, but VLBW also exerts an independent adverse effect.
- An interaction between VLBW and social risk was observed for verbal IQ, but in an unexpected direction.
Abstract:
We tested the hypothesis that very low birth weight (VLBW < 1.5 kg) children would have significantly poorer neurocognitive abilities at school age than would normal birth weight full-term age mates, that differences would persist after control for neurologic impairment and social risk, and that VLBW would interact with social risk. Two hundred forty-nine VLBW children and a randomly selected sample of 363 normal birth weight age mates born 1977 through 1979 were tested at 8 years. A neurologic examination and tests of intelligence, language, speech, reading, mathematics, spelling, visual and fine motor abilities, and behavior were performed. Twenty-four (10%) VLBW had a major neurologic abnormality compared with none of the controls. VLBW had significantly poorer scores on all tests, with the exception of speech and the total behavior score. These differences persisted among VLBW children without major neurologic abnormality, with the exception of social competence, reading, and spelling. Even normal IQ, neurologically normal VLBW had significantly poorer scores than did controls in expressive language, memory, visuomotor, and fine motor function, and measures of hyperactivity. When social risk was controlled in multiple regression analyses, VLBW still had an adverse effect on all outcome measures with the exception of speech. Social risk was, however, the major determinant of outcome. We found an interaction between VLBW and social risk only in verbal IQ and in the opposite direction than hypothesized.