Long term cognitive outcomes of early term (37-38 weeks) and late preterm (34-36 weeks) births: A systematic review
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Published on: January 12, 2018
Sarah R Murray1, Susan D Shenkin2, Kirsten McIntosh3
1Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, EH16 4TJ, UK.
Insights
Children born at full term (39-41 weeks) show higher cognitive scores than early term infants (37-38 weeks). Data on late preterm birth (34-36 weeks) cognitive outcomes is limited, with no significant differences found compared to full term.
Area of Science:
- Pediatric Health
- Developmental Psychology
- Neonatal Medicine
Background:
- Limited evidence exists on long-term cognitive outcomes for late preterm (34-36 weeks) and early term (37-38 weeks) births.
- Understanding these outcomes is crucial for optimizing delivery timing and neonatal care.
Purpose of the Study:
- To systematically review and assess the long-term cognitive outcomes of children born at late preterm and early term gestations.
- To compare cognitive development in infants born at 37-38 weeks and 34-36 weeks gestation with those born at full term.
Main Methods:
- A systematic review was conducted using four major electronic databases (Medline, Embase, clinicaltrials.gov, PsycINFO) with a final search in August 2016.
- Studies were included if they reported gestational age, IQ measures, and age at assessment, with data abstracted and critically appraised by two independent reviewers.
- The review protocol was registered with PROSPERO (CRD42015015472).
Main Results:
- Analysis of seven studies involving 41,344 children revealed that full-term infants (39-41 weeks) had higher cognitive scores than early term infants (37-38 weeks), with approximately 3 IQ points difference.
- Studies on late preterm births (34-36 weeks) showed no significant cognitive outcome differences compared to term births, but these studies had high risk of bias and varied methodologies.
- Cognitive score increases were observed for each additional week of gestation within the early term period.
Conclusions:
- Infants born at 39-41 weeks gestation demonstrate superior cognitive outcomes compared to those born at 37-38 weeks.
- The findings suggest that optimizing delivery timing to full term may be beneficial for cognitive development.
- Further research with robust methodologies is needed to clarify the long-term cognitive outcomes for late preterm infants due to data scarcity and high bias in existing studies.
Abstract:
Background: There is a paucity of evidence regarding long-term outcomes of late preterm (34-36 weeks) and early term (37-38 weeks) delivery. The objective of this systematic review was to assess long-term cognitive outcomes of children born at these gestations. Methods: Four electronic databases (Medline, Embase, clinicaltrials.gov and PsycINFO) were searched. Last search was 5 th August 2016. Studies were included if they reported gestational age, IQ measure and the ages assessed. The protocol was registered with the International prospective register of systematic reviews (PROSPERO Record CRD42015015472). Two independent reviewers assessed the studies. Data were abstracted and critical appraisal performed of eligible papers. Results: Of 11,905 potential articles, seven studies reporting on 41,344 children were included. For early term births, four studies (n = 35,711) consistently showed an increase in cognitive scores for infants born at full term (39-41 weeks) compared to those born at early term (37-38 weeks) with increases for each week of term (difference between 37 and 40 weeks of around 3 IQ points), despite differences in age of testing and method of IQ/cognitive testing. Four studies (n = 5644) reporting childhood cognitive outcomes of late preterm births (34 - 36 weeks) also differed in study design (cohort and case control); age of testing; and method of IQ testing, and found no differences in outcomes between late preterm and term births, although risk of bias was high in included studies. Conclusion: Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks). This should be considered when discussing timing of delivery. For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores.
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