Executive Function Outcomes at School Age in Children Born Moderate-to-Late Preterm

To compare executive function (EF) outcomes at school age between children born moderate-to-late preterm (MLP; 32-36 weeks' gestation) and term (≥37 weeks' gestation) across subdomains of attentional control, cognitive flexibility, goal setting, and everyday executive behaviors.

Two hundred one children born MLP and 201 born at term were recruited from the Royal Women's Hospital, Melbourne, Australia. Children completed EF measures at 9 years of corrected age. Group differences in mean or median outcome z-scores were estimated using linear or quantile regression. EF impairment risk ratios [RRs] between groups were estimated using generalized linear models. Analyses were adjusted for multiple birth and social risk.

One hundred fifty-nine children born MLP (79%) and 134 born at term (67%) were assessed. Compared with the term group, the MLP group performed poorer in goal setting (mean difference = -0.26, 95% CI = -0.50, -0.03, P = .03) and cognitive flexibility (mean difference = -0.32, 95% CI = -0.59, -0.05, P = .02). Children born MLP were at increased risk of behavioral executive dysfunction (RR = 1.86, 95% CI = 1.05, 3.27, P = .03), impairments in cognitive flexibility (RR = 1.80, 95% CI = 1.05, 3.09, P = .03), and goal setting (RR = 1.69, 95% CI = 1.08, 2.65, P = .02).

Children born MLP demonstrate a pattern of increased EF difficulties at school-age compared with term children, mostly within the goal setting subdomain. These difficulties are likely to affect other outcomes such as academic performance and social skills.