Neonatal brain abnormalities predict preschool executive functioning performance in children born very preterm

Children born prematurely consistently exhibit deficits on performance-based and caregiver-report measures of executive functioning (EF). As early EF may mediate premature childbirth's impact on neurodevelopmental and behavioral outcomes, it is important to understand risk factors for EF deficits. Data from a longitudinal prospective cohort study were used to explore the association of brain abnormalities with EF measures in very preterm children (≤32 weeks of age). Participants included 314 very preterm children (M = 69.5, SD = 2.0 months of age; 51.9% male; 71.3% White). Regression analyses evaluated whether the global brain abnormality composite score on magnetic resonance imaging at term-equivalent age was associated with EF performance and caregiver ratings at 5-year corrected age, as well as which specific aspects of regional abnormalities (i.e., white matter, grey matter, cerebellar, and deep nuclear grey matter abnormalities) predicted EF. The global brain abnormality score significantly predicted poorer EF performance but not caregiver-rated EF, independent of known confounders (sex, gestational age, birthweight, social risk, chorioamnionitis, hypertensive disorders, bronchopulmonary dysplasia, retinopathy of pre-maturity, and global developmental delay). Exploratory analyses revealed that cerebellar abnormalities were associated with poorer working memory, inhibition, and cognitive flexibility and spatial working memory, and white matter abnormalities were associated with poorer planning. This study adds to the research showing that brain abnormalities associated with premature birth consistently predict poorer scores on performance-based measures of EF. Conventional magnetic resonance imaging at term-equivalent age may assist with identifying at-risk children when interpreted in the context of other influences on child EF such as family social circumstances and functioning. (PsycInfo Database Record (c) 2026 APA, all rights reserved).