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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurocognitive and Academic Outcomes at Age 10 Years of Extremely Preterm Newborns
Robert M Joseph1, Thomas M O'Shea2, Elizabeth N Allred3
1Departments of Anatomy and Neurobiology and rmjoseph@bu.edu.
Insights
Children born extremely preterm face lasting neurocognitive deficits, with over half showing moderate to severe impairments by age 10. Lowest gestational age correlates with the highest risk of poor cognitive and academic outcomes.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Neuroscience
Background:
- Extremely preterm infants (<28 weeks' gestation) face high risks for neurocognitive deficits.
- Previous studies show up to 40% experience significant cognitive issues by school age.
Purpose of the Study:
- To assess neurocognitive impairment rates in a contemporary US cohort of extremely preterm children at age 10.
- To identify factors associated with neurocognitive outcomes in this population.
Main Methods:
- A cohort of 873 children born <28 weeks' gestation were assessed at age 10.
- Comprehensive evaluations included IQ, language, attention, executive function, processing speed, visual-motor skills, and academic achievement.
Main Results:
- Over half of the cohort exhibited moderate to severe neurocognitive deficits.
- Scores were consistently below normative expectations, particularly in executive control and processing speed.
- Lower gestational age was significantly associated with poorer outcomes across 18 measures.
Conclusions:
- Extremely preterm children remain at high risk for persistent neurocognitive and academic impairments.
- The lowest gestational ages present the greatest risk.
- Early childhood monitoring and remediation are crucial for mitigating these outcomes.
Background And Objective:
Despite reductions in mortality and morbidity among children born extremely preterm, they remain at high risk of neurocognitive deficits, with up to 40% having significant cognitive deficits at school age. We assessed the rate of neurocognitive impairment in a contemporary US cohort of 873 children aged 10 years who were born <28 weeks' gestation.
Methods:
The families of 889 of 966 (92%) children enrolled from 2002 to 2004 at 14 sites in 5 states returned at age 10 years for a comprehensive assessment of IQ, language, attention, executive function, processing speed, visual perception, visual-motor function, and academic achievement.
Results:
A total of 873 children were assessed with well-validated tests of cognitive and academic function. Distributions of test scores were consistently and markedly shifted below normative expectation, with one-third to two-thirds of children performing >1 SD below age expectation. The most extreme downward shifts were on measures of executive control and processing speed. Multivariate analyses, adjusted for socioeconomic status, growth restriction, and other potential confounders, revealed that the risk of poor outcome was highest at the lowest gestational age across all 18 measures.
Conclusions:
More than half of our extremely preterm cohort exhibited moderate or severe neurocognitive deficits at age 10 years, with the most extensive impairments found among those born at the lowest gestational age. Children born extremely preterm continue to be at significant risk of persistent impairments in neurocognitive function and academic achievement, underscoring the need for monitoring and remediating such outcomes beginning in early childhood.
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