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Updated: Feb 28, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Early predictors of cognitive trajectories from birth to adolescence in children born extremely preterm

Stephen R Hooper1, Robert M Joseph2, T Michael O Shea3

  • 1Departments of Health Sciences and Psychiatry, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.

Developmental Medicine and Child Neurology
|February 26, 2026
PubMed

Insights

Cognitive development in extremely preterm children is impacted by social disadvantage, male sex, bronchopulmonary dysplasia (BPD), white matter injury (WMI), and inflammation. Addressing these factors may improve long-term cognitive outcomes.

Area of Science:

  • Neuroscience
  • Developmental Pediatrics
  • Neonatology

Background:

  • Extremely preterm birth poses significant risks to neurodevelopment.
  • Longitudinal data on cognitive trajectories in this population are crucial for understanding developmental patterns.

Purpose of the Study:

  • To predict cognitive ability trajectories from ages 2 to 15 years in children born extremely preterm.
  • To identify early-life factors influencing these cognitive trajectories.

Main Methods:

  • Longitudinal cohort study of 659 extremely preterm infants (23-27 weeks gestation).
  • Cognitive assessments at ages 2, 10, and 15 years.
  • Analysis included maternal/neonatal factors, comorbidities, and inflammatory markers.

Main Results:

  • Social disadvantage, male sex, lower gestational age (23-24 weeks), bronchopulmonary dysplasia (BPD), white matter injury (WMI), and elevated neonatal inflammatory proteins were linked to lower cognitive scores.
  • WMI's negative effect on cognition was observed regardless of social disadvantage.
  • Social disadvantage had a greater impact on cognitive outcomes in children without WMI.

Conclusions:

  • Social disadvantage, male sex, BPD, WMI, and neonatal inflammation are associated with slower cognitive gains in extremely preterm children.
  • Early WMI moderates the relationship between social disadvantage and cognitive function.
  • Interventions targeting neonatal morbidities and social factors are essential for improving cognitive outcomes.
Abstract

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