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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Attention problems in a representative sample of extremely preterm/extremely low birth weight children
Peter J Anderson1, Cinzia R De Luca, Esther Hutchinson
1Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia. peter.anderson@mcri.edu.au
Insights
Children born extremely preterm (EP) or extremely low birth weight (ELBW) face higher risks of attention deficits. Close monitoring of attention functioning is crucial for these children throughout development.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Children born extremely preterm (EP) or extremely low birth weight (ELBW) may experience developmental challenges.
- Attention and executive functions are critical for academic and social success.
Purpose of the Study:
- To investigate attention functioning in a large cohort of children born EP/ELBW.
- To compare attention outcomes between EP/ELBW children and full-term, normal birth weight (FT/NBW) children.
- To identify predictors of attention impairments in EP/ELBW children.
Main Methods:
- A cohort of 189 EP/ELBW children and 173 FT/NBW children were assessed at 8 years of age.
- Cognitive assessments included subtests from the Test of Everyday Attention for Children (TEA-Ch) and Wechsler Intelligence Scale for Children-4th Edition (WISC-IV).
- Behavioral inattention was evaluated using the Behavior Rating Inventory of Executive Function (BRIEF) and Conners' ADHD/DSM-IV Scale (CADS-P).
Main Results:
- The EP/ELBW group showed poorer performance on most attention measures and higher rates of attention deficits compared to the FT/NBW group.
- Inhibition was the only measure where the EP/ELBW group did not perform significantly worse.
- Necrotizing enterocolitis (NEC) and cystic periventricular leukomalacia (PVL) were independent predictors of selective attention deficits.
Conclusions:
- Children born EP/ELBW are at significantly increased risk for attentional impairments.
- Attention functioning should be closely monitored in EP/ELBW children during development.
- Neonatal medical factors like NEC and PVL may impact specific attention domains.
Abstract:
The aim of this study was to examine attention in a large, representative, contemporary cohort of children born extremely preterm (EP) and/or extremely low birth weight (ELBW). Participants included 189 of 201 surviving children born EP (<28 weeks' gestation) or ELBW (<1,000 g) in 1997 in the state of Victoria, Australia. A comparison group of 173 of 199 children born full term and normal birth weight (FT/NBW) were randomly selected matching for birth hospital, expected due date, gender, mother's country of birth, and health insurance status. Participants were assessed at 8 years of age on subtests from the Test of Everyday Attention for Children (TEA-Ch) and the Wechsler Intelligence Scale for Children-4th Edition (WISC-IV). Measures of selective attention, sustained attention, attention encoding, and executive attention (inhibition, shifting attention, and divided attention) were administered. To assess behavioral elements of inattention, the primary caregiver completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Conners' ADHD/DSM-IV Scale (CADS-P). The EP/ELBW group performed more poorly across all cognitive and behavioral measures than the FT/NBW group, with the exception of inhibition. The EP/ELBW group also had significantly elevated rates of impairment in selective, sustained, shifting and divided attention, as well as attention deficit hyperactivity disorder (ADHD) symptoms. No significant gender or gradient effects (e.g., <26 weeks' gestation vs. ≥ 26 weeks' gestation) were identified. Neonatal medical factors were not strong predictors of attention, although necrotizing enterocolitis (NEC) and cystic periventricular leukomalacia (PVL) were independent predictors of selective attention. In conclusion, our comprehensive assessment of attention provides strong evidence that children born EP/ELBW are at increased risk for attentional impairments, and as such, this population should be monitored closely during early and middle childhood with a focus on attention functioning.
