Cognitive deficit in preschoolers born late-preterm

Area of Science:

• Neonatalogy
• Developmental Psychology
• Pediatric Neurology

Background:

• Late-preterm (LPT) birth (35-36 weeks gestation) constitutes the majority of preterm births.
• LPT infants were previously considered at low risk for adverse cognitive outcomes.
• Complicated LPT (cLPT) preschoolers, requiring neonatal intensive care unit (NICU) admission, have demonstrated cognitive deficits.

Purpose of the Study:

• To compare cognitive outcomes in complicated LPT (NICU-admitted) and uncomplicated LPT (uLPT; NICU non-admitted) preschoolers.
• To identify specific cognitive domains affected in cLPT children.
• To investigate the influence of neonatal morbidities and gender on cognitive development in LPT children.

Main Methods:

• A single-center retrospective cohort study included 118 LPT children (born 2004-2006) and 100 term-born controls.
• Participants were categorized as cLPT (n=90) or uLPT (n=28).
• General conceptual ability (GCA) was assessed using the Differential Ability Scales, Second Edition (DAS-II).

Main Results:

• Complicated LPT children exhibited significantly poorer scores in General Conceptual Ability (GCA), Nonverbal Reasoning, and Spatial domains compared to term-born children.
• Higher rates of impairment in Nonverbal Reasoning and Spatial skills were observed in the cLPT group.
• Uncomplicated LPT children did not differ from term-born controls in cognitive outcomes.
• LPT males showed significantly higher risks for nonverbal and GCA deficits compared to term-born males and LPT females.

Conclusions:

• Neonatal morbidities, particularly those requiring NICU admission (e.g., clinical instability, low birth weight), contribute to subtle cognitive deficits in LPT preschoolers.
• Male gender acts as an additive risk factor for cognitive impairment in LPT children.
• Late-preterm gestational age alone is not a reliable predictor of long-term neurocognitive outcome; neonatal factors are critical.