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Prognostic Factors for Poor Cognitive Development in Children Born Very Preterm or With Very Low Birth Weight: A
Louise Linsell1, Reem Malouf1, Joan Morris2
1National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England.
Insights
Predictors of cognitive delay in very preterm (VPT) or very low birth weight (VLBW) children include male sex, nonwhite race, and lower parental education. Environmental factors become more significant as children age.
Area of Science:
- Neonatal care and developmental pediatrics
- Neuroscience and child psychology
Background:
- Cognitive delay is a common impairment in children born very preterm (VPT) or with very low birth weight (VLBW).
- Identifying predictors of long-term cognitive outcomes is crucial for effective healthcare and educational planning.
Purpose of the Study:
- To identify prognostic factors associated with poor cognitive development in children born VPT or with VLBW.
Main Methods:
- A systematic review of studies published between 1990 and 2014 was conducted.
- Databases searched included MEDLINE, EMBASE, and PyscINFO for multivariable prediction models of neurodevelopment in VPT or VLBW children.
- Thirty-one studies with 98 risk factor models were analyzed, with data extraction and risk-of-bias assessment by two independent reviewers.
Main Results:
- In children under 5 years, male sex, nonwhite race/ethnicity, lower parental education, and lower birth weight predicted cognitive impairment.
- Parental education remained a significant predictor in older children.
- Male sex predicted early language impairment but not in middle childhood; gestational age was a poor predictor.
Conclusions:
- Perinatal risk factors have a diminishing influence on cognitive development over time, with environmental factors becoming more important.
- Distinguishing cognitive outcomes from motor and neurosensory impairments presents challenges.
- Strategies for assessing untestable children impact risk prediction accuracy.
Importance:
Cognitive delay is the most common form of impairment among children born very preterm (VPT) at 32 weeks or less or with very low birth weight (VLBW) of 1250 g or less. It is important to identify factors that are robust predictors of long-term outcome because the ability to predict future prognosis will assist in health care and educational service planning and provision.
Objective:
To identify prognostic factors for poor cognitive development in children born VPT or with VLBW.
Evidence Review:
A systematic review was conducted using MEDLINE, EMBASE, and PyscINFO databases to identify studies published between January 1, 1990, and June 1, 2014, reporting multivariable prediction models for neurodevelopment in VPT or VLBW children. Thirty-one studies comprising 98 risk factor models for cognitive outcome were identified. Two independent reviewers extracted key information on study design, outcome definition, risk factor selection, model development, and reporting and conducted a risk-of-bias assessment.
Findings:
There was evidence that male sex, nonwhite race/ethnicity, lower level of parental education, and lower birth weight were predictive of global cognitive impairment in children younger than 5 years. In older children, only the influence of parental education was sustained. Male sex was also predictive of language impairment in early infancy, but not in middle childhood. Gestational age was a poor predictor of cognitive outcome, probably because of a reduced discriminatory power in cohorts restricted to a narrow gestational age range. The prognostic value of neonatal brain injury was unclear; however, studies adopted mixed strategies for managing children with physical or neurosensory disability.
Conclusions And Relevance:
The influence of perinatal risk factors on cognitive development of VPT or VLBW children appears to diminish over time as environmental factors become more important. It is difficult to isolate cognitive outcomes from motor and neurosensory impairment, and the strategy for dealing with untestable children has implications for risk prediction.
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