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Published on: September 6, 2017
Latent class growth analysis identified different trajectories in cognitive development of extremely low birthweight
Anu Haavisto1,2, Liisa Klenberg3, Viena Tommiska4
1Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland anu.haavisto@helsinki.fi.
Insights
Cognitive trajectories in extremely low birthweight (ELBW) children vary; those with average or below-average scores at age 5 showed declines by age 11. Neonatal complications and lower maternal education are risk factors for lower intelligence in ELBW children.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Extremely low birthweight (ELBW) children exhibit significant individual variation in cognitive development.
- Longitudinal studies indicate diverse developmental trajectories in this population.
- Understanding these trajectories is crucial for targeted interventions.
Purpose of the Study:
- To characterize distinct cognitive developmental trajectories in extremely low birthweight (ELBW) children from preschool to preteen age.
- To identify factors influencing cognitive development in ELBW children.
- To provide insights for clinical management of ELBW individuals.
Main Methods:
- Prospective neurocognitive follow-up study of 115 extremely low birthweight (ELBW) children.
- Cognitive assessments using standardized intelligence tests at median ages of 5.0 and 11.3 years.
- Latent class growth analysis to identify developmental trajectories.
Main Results:
- Three distinct cognitive trajectories were identified in ELBW children.
- Children with average or below-average intelligence at age 5 experienced significant score decreases by age 11.
- Above-average intelligence remained stable, while neonatal complications and maternal education predicted lower intelligence at follow-up.
Conclusions:
- Extremely low birthweight (ELBW) children form a heterogeneous group with identifiable cognitive trajectories.
- Cognitive deterioration is more likely in ELBW children with initially average or below-average performance.
- Neonatal complications and lower maternal education are significant risk factors for poorer cognitive outcomes in ELBW children.
Background:
Recent longitudinal studies suggest stable cognitive development in preterm children, although with great individual variation. This prospective neurocognitive follow-up study of extremely low birthweight (ELBW, <1000 g) children aimed to characterise groups with different developmental trajectories from preschool to preteen age.
Methods:
ELBW children (n=115) born in Finland in 1996-1997 participated in cognitive assessments at a median age of 5.0 years and 11.3 years. A standardised test of intelligence (Wechsler Preschool and Primary Scale of Intelligence-Revised or Wechsler Intelligence Scale for Children-third edition) was administered at both ages.
Results:
Three ELBW groups with different developmental trajectories over time were identified with latent class growth analysis. Children with average (Full-Scale IQ (FSIQ): 85-115) and below average (FSIQ: <85) intelligence at 5 years of age had significant decreases in intelligence scores by 11 years of age (-11.7 points and -14.9 points, respectively, both p<0.001), while those with above average intelligence (FSIQ: >115) showed stable development (-3.2 points, p=0.250). Multiple linear regression showed that neonatal complications (intraventricular haemorrhage grade 3-4 and blood culture positive sepsis) and maternal education significantly predicted lower intelligence at the second assessment (F(3,106)=7.27, p<0.001, adjusted R2=0.147).
Conclusions:
ELBW children represent a heterogeneous patient population in which groups with different cognitive trajectories can be detected. Deterioration may occur particularly in children with initial average or below average cognitive performance at 5 years of age, with neonatal complications and lower maternal education presenting as risk factors. Catch-up in cognitive functions seems more uncommon in the ELBW population, which should be noted in clinical work.
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