Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis.

Full Abstract

CONTEXT:
The cognitive and behavioral outcomes of school-aged children who were born preterm have been reported extensively. Many of these studies have methodological flaws that preclude an accurate estimate of the long-term outcomes of prematurity.

OBJECTIVE:
To estimate the effect of preterm birth on cognition and behavior in school-aged children.

DATA SOURCES:
MEDLINE search (1980 to November 2001) for English-language articles, supplemented by a manual search of personal files maintained by 2 of the authors.

STUDY SELECTION:
We included case-control studies reporting cognitive and/or behavioral data of children who were born preterm and who were evaluated after their fifth birthday if the attrition rate was less than 30%. From the 227 reviewed studies, cognitive data from 15 studies and behavioral data from 16 studies were selected.

DATA EXTRACTION:
Data on population demographics, study characteristics, and cognitive and behavioral outcomes were extracted from each study, entered in a customized database, and reviewed twice to minimize error. Differences between the mean cognitive scores of cases and controls were pooled. Homogeneity across studies was formally tested using a general variance-based method and graphically using Galbraith plots. Linear meta-analysis regression models were fitted to explore the impact of birth weight and gestational age on cognitive outcomes. Study-specific relative risks (RRs) were calculated for the incidence of attention-deficit/hyperactivity disorder (ADHD) and pooled. Quality assessment of the studies was performed based on a 10-point scale. Publication bias was examined using Begg modified funnel plots and formally tested using the Egger weighted-linear regression method.

DATA SYNTHESIS:
Among 1556 cases and 1720 controls, controls had significantly higher cognitive scores compared with children who were born preterm (weighted mean difference, 10.9; 95% confidence interval [CI], 9.2-12.5). The mean cognitive scores of preterm-born cases and term-born controls were directly proportional to their birth weight (R(2) = 0.51; P<.001) and gestational age (R(2) = 0.49; P<.001). Age at evaluation had no significant correlation with mean difference in cognitive scores (R(2) = 0.12; P =.20). Preterm-born children showed increases in externalizing and internalizing behaviors in 81% of studies and had more than twice the RR for developing ADHD (pooled RR, 2.64; 95% CI, 1.85-3.78). No differences were noted in cognition and behaviors based on the quality of the study.

CONCLUSIONS:
Children who were born preterm are at risk for reduced cognitive test scores and their immaturity at birth is directly proportional to the mean cognitive scores at school age. Preterm-born children also show an increased incidence of ADHD and other behaviors.

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Author information

Author/s: Bhutta, Adnan T (AT); Cleves, Mario A (MA); Casey, Patrick H (PH); Cradock, Mary M (MM); Anand, K J S (KJ);

Affiliation: Department of Pediatrics, Arkansas University for Medical Sciences, Little Rock, USA.

Grants: HD36484-02 (Agency:NICHD NIH HHS)

Journal and publication information

Publication Type: Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.

Journal: JAMA : the journal of the American Medical Association (JAMA), published in United States. (Language: eng)

Reference: 2002-Aug; vol 288 (issue 6) : pp 728-37

Dates: Created 2002/08/09; Completed 2002/08/22; Revised 2007/11/14;

PMID: 12169077, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: JAMA. 2002 Nov 27;288(20):2542-3; author reply 2543. (PMID: 12444858)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Attention Deficit Disorder with Hyperactivity
Child
Child Behavior
Child Behavior Disorders
Child Development
Cognition
Developmental Disabilities
Female

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