Impact of gestational age on child intelligence, attention and executive function at age 5: a cohort study

ObjectivesPreterm birth can affect cognition, but other factors including parental education and intelligence may also play a role, but few studies have adjusted for these potential confounders. We aimed to assess the impact of gestational age (GA), late preterm birth (34 to <37 weeks GA) and very to moderately preterm birth (<34 weeks GA) on intelligence, attention and executive function in a population of Danish children aged 5 years.DesignPopulation-based prospective cohort study.SettingDenmark 2003–2008.ParticipantsA cohort of 1776 children and their mothers sampled from the Danish National Birth Cohort with information on GA, family and background factors and completed neuropsychological assessment at age 5.Primary outcome measuresWechsler Preschool and Primary Scale of Intelligence-Revised, Test of Everyday Attention for Children at Five and Behaviour Rating Inventory of Executive Function scores.ResultsFor preterm birth <34 weeks GA (n=8), the mean difference in full-scale intelligence quotient(IQ) was −10.6 points (95% CI −19.4 to −1.8) when compared with the term group ≥37 weeks GA (n=1728), and adjusted for potential confounders. For the teacher-assessed Global Executive Composite, the mean difference was 5.3 points (95% CI 2.4 to 8.3) in the adjusted analysis, indicating more executive function difficulties in the preterm group <34 weeks GA compared with the term group. Maternal intelligence and parental education were weak confounders. No associations between late preterm birth 34 to <37 weeks GA (n=40) and poor cognition were shown.ConclusionsThis study showed substantially lower intelligence and poorer executive function in children born <34 weeks GA compared with children born at term. GA may play an important role in determining cognitive abilities independent of maternal intelligence and parental education. Studies with larger sample sizes are needed to confirm these findings, as the proportion of children born preterm in this study population was small.

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Morbidity in Late Preterm Birth: A Retrospective Cohort Study Assessing the Role of Immaturity versus Antecedent Factors

Neonatology ◽

10.1159/000515089 ◽

2021 ◽

pp. 1-8

Author(s):

Melissa Lorenzo ◽

Megan Laupacis ◽

Wilma M. Hopman ◽

Imtiaz Ahmad ◽

Faiza Khurshid

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Preterm Delivery ◽

Gestational Age ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Late Preterm ◽

Multiple Gestation ◽

Late Preterm Birth ◽

Apnea Of Prematurity

Introduction: Late preterm infants (LPIs) are infants born between 340/7 and 366/7 weeks gestation. Morbidities in these infants are commonly considered a result of prematurity; however, some research has suggested immaturity may not be the sole cause of morbidities. We hypothesize that antecedents leading to late preterm birth are associated with different patterns of morbidities and that morbidities are the result of gestational age superimposed by the underlying etiologies of preterm delivery. Methods: This is a retrospective cohort study of late preterm neonates born at a single tertiary care center. We examined neonatal morbidities including apnea of prematurity, hyperbilirubinemia, hypoglycemia, and the requirement for continuous positive airway pressure (CPAP). Multivariable logistic regression analysis was performed to estimate the risk of each morbidity associated with 3 categorized antecedents of delivery, that is, spontaneous preterm labor, preterm premature rupture of membranes (PPROM), and medically indicated birth. We calculated the predictive probability of each antecedent resulting in individual morbidity across gestational ages. Results: 279 LPIs were included in the study. Decreasing gestational age was associated with significantly increased risk of apnea of prematurity, hyperbilirubinemia, and requirement of CPAP. In our cohort, the risk of hypoglycemia increased with gestational age, with the greatest incidence at 360−6 weeks. There was no significant association of risk of selected morbidities and the antecedents of late preterm delivery, with or without adjustment for gestational age, multiple gestation, small for gestational age (SGA), antenatal steroids, and delivery method. Discussion and Conclusion: This study found no difference in morbidity risk related to 3 common antecedents of preterm birth in LPIs. Our research suggests that immaturity is the primary factor in determining adverse outcomes, intensified by factors resulting in prematurity.

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