| 1. |
- Aiko, Lundequist, 1973-, et al.
(författare)
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The Stockholm Neonatal Project : Cognitive and executive functioning in adolecents born preterm
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: Research has shown that premature birth poses a risk for later cognitive development, particularly in the executive domain, but few studies extend beyond the early school years. Adolescence is a critical period for cognitive maturation, and this study investigated the cognitive outcome in a Swedish cohort of prematurely born 18-year olds, in relation to gestational age at birth and medical risks in the perinatal period.Participants and Methods: As part of Stockholm Neonatal Project, 134 adolescents born preterm with very low birth weight (< 1500g) and 94 matched controls born at term, participated in a follow-up study at age 18. General intelligence, as well as executive, memory, language and visual motor functions were measured by WISC-III, Delis-Kaplan Executive Function System, naming tests, Rey Auditory Verbal Learning test, face recognition, and Visual Motor Integration test.Results: Extremely preterm adolescents (EPT, GA 23-27, n=74) performed worse than adolescents born either very preterm or at term, on all cognitive tasks and particularly on executive measures. 50% of the EPT group had suffered perinatal medical complications, and had more pervasive cognitive deficits than EPTs with low medical risk. By contrast, very preterm adolescents (GA 28-31; n=36) performed consistently on a par with the controls. Moderately preterm with very low birth weight (GA 32-36; n=25), who had experienced varying degrees of intrauterine growth retardation, tended to score lower than very preterm and control adolescents, particularly on complex cognitive measures.Conclusions: Extremely preterm birth per se poses a risk for long-term cognitive outcome, particularly in executive functions. These risks may be exacerbated by medical complications. Children born after 28 weeks of gestation or later, with normal birth weight and no perinatal complications, do not have an elevated risk for cognitive deficits at age 18.
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| 2. |
- Böhm, Birgitta
(författare)
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Risk and resilience in children born preterm : cognitive and executive functioning at 5 1/2 years of age
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- We investigated the intellectual outcome of two cohorts of preterm children, born from 1988 to 1993 and 1994 to 1997, respectively. A population-based follow-up study (the Stockholm Neonatal Project) included 182 children with a birth weight of 1500 g or less (very-low-birthweight: VLBW) and a control group of 125 children born healthy at term who were examined with the Wechsler Preschool and Primary Scale-Revised (WPPSI-R) and a neuropsychological test battery (Nepsy) at 5½ years of age ((paper I-IV). Paper V includes the results from 11 preterm children treated according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) and a control group of 15 likewise preterm children who had a conventional care at the NICU. The test design was the same in the two studies. The WPPSI-R results of the VLBW children fell well within the normal range: WPPSI-R full scale (FSIQ) 95.7, verbal subscale (VIQ) 99.9 and 91.6 for the performance subscale (PIQ).The term born control group had significantly better results than the VLBW group. This could partly be attributed to the greater variability of the VLBW group, with a larger proportion falling in the lower area of the IQ distribution, specifically for PIQ. Paternal education was equal in the two groups and was found to be the single most important predictor of IQ for all children. The frequency of bilingualism was the same in the VLBW and control groups and was negatively associated with verbal and full scale IQ, but to a minor degree. Visual impairment was inversely associated with all three IQ scores. The severe form of retinopathy of prematurity (ROP), visual impairment and intrauterine growth retardation turned out to be negatively related to FSIQ and PIQ, while paternal education acted as a protective factor. With a small sample of the VLBW and control children we used diffusion tensor imaging to show the white matter microstructure, as preterm birth frequently involves white matter injury affecting long-term neurological and cognitive outcomes. We found that the preterm group had lower fractional anisotropy values in the posterior corpus callosum and bilaterally in the internal capsules. In the posterior corpus callosum, this difference may partially be related to a difference in white matter volume between the groups. The analysis failed to indicate a group difference in the axonal organization. These results are in agreement with previous diffusion tensor imaging findings in newborn preterm children and indicate that ex-preterm children with attention deficits have white matter disturbances that are not compensated for, or repaired, before 11 years of age. To explore whether children born preterm have deficient executive functions (EF) in comparison with children born at full term, we analysed the results from several of the Nepsy tests. We found that the controls surpassed the VLBW children on tests of EF, even after controlling for intelligence (IQ). EF was associated with retinopathy of prematurity (ROP), and with visual impairment as a whole. In both groups, girls surpassed boys on test outcome .We conclude that it is possible to analyse executive functions already in pre-school age. Preterm infants with chronic lung disease (CLD) had impaired cognitive development and poorer eye-hand coordination at 10 months of age. We examined whether this effect of CLD persisted until school age and whether the severity of CLD affected the outcome. The group included 32 VLBW without known brain insult and 28 controls. The groups did not differ significantly in cognitive outcome;. FSIQ of 94.4 and 99.1, VIQ of 99.6 and 101.5, and PIQ 90.9 and 96.7 respectively. Similarly, no difference was found in tests of eye-hand control. The children with the most severe form of CLD had significantly lower PIQ,(84.8), and FSIQ, 87.6 and worse visual-motor performance than the controls. CLD grade III, together with visual impairment had a significant relation to IQ. NIDCAP was evaluated as a positive alternative to conventional care of very preterm infants. We studied the 5 years development in children treated and there were no significant differences between the groups in FSIQ: 93.4 vs. 89.6; VIQ 93.6 vs. 93.7 or PIQ 94.3 vs. 86.3 Overall, the differences in survival, attention and cognition were in favour of the NIDCAP children. Our trial suggests a positive impact by NIDCAP on attention behaviour at preschool age, but the small samples, which implies a low power, calls for caution in interpreting our findings. Larger trials in different cultural contexts are warranted.
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| 3. |
- Böhm, Birgitta, et al.
(författare)
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Visual-motor and executive functions in children born preterm : The Bender Visual Motor Gestalt Test revisited
- 2010
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Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 51:5, s. 376-384
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Tidskriftsartikel (refereegranskat)abstract
- Visual-motor development and executive functions were investigated with the Bender Test at age 51/2 years in 175 children born preterm and 125 full-term controls, within the longitudinal Stockholm Neonatal Project. Assessment also included WPPSI-R and NEPSY neuropsychological battery for ages 4-7 (Korkman, 1990). Bender protocols were scored according to Brannigan & Decker (2003), Koppitz (1963) and a complementary neuropsychological scoring system (ABC), aimed at executive functions and developed for this study. Bender results by all three scoring systems were strongly related to overall cognitive level (Performance IQ), in both groups. The preterm group displayed inferior visual-motor skills compared to controls also when controlling for IQ. The largest group differences were found on the ABC scoring, which shared unique variance with NEPSY tests of executive function. Multiple regression analyses showed that hyperactive behavior and inattention increased the risk for visual-motor deficits in children born preterm, whereas no added risk was seen among hyperactive term children. Gender differences favoring girls were strongest within the preterm group, presumably reflecting the specific vulnerability of preterm boys. The results indicate that preterm children develop a different neurobehavioral organization from children born at term, and that the Bender test with a neuropsychological scoring is a useful tool in developmental screening around school start.
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| 4. |
- Fredriksson Kaul, Ylva
(författare)
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From Eye to Mind : Early Visuomotor Performance and Developmental Trajectories in Children Born Preterm
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Children born very preterm, at less than 32 weeks of gestation, have an increased risk of developing problems with attention, cognition, perception and motor function. Despite this, the developmental trajectories leading from preterm birth to later impairments are not fully understood.This thesis focused on investigating the development of the visuomotor system in infants born very preterm, in relation to neurodevelopment at 2.5-3 years (including cognitive, language and motor functions) and 6.5 years (including cognitive functions and attention). Two early visuomotor functions were investigated: at 4 months of corrected age we looked at their visual tracking of moving objects and at 8 months of corrected age we examined how they reached for moving objects. Visual tracking performance is the ability to follow, sustain attention on and predict the future positions of a moving object. When infants reach for moving objects, these requirements are enhanced by movements of the arm and hand.This was a prospective, population-based cohort study of children born very preterm in 2004-2007, who were longitudinally assessed from the neonatal period until 6.5 years of age. The results showed that the two most important early visual tracking parameters were gaze gain, which is effectively combining eye and head movements to follow the trajectory of the object, and timing of gaze to the motion of the object. Gaze gain correlated with neurodevelopment at 2.5-3 years and with cognition and attention at 6.5 years. Early reaching was also related to outcomes at 2.5-3 years, but the pattern differed for children born before and after 28 weeks of gestation. Parameters of prediction and movement planning were the most important factors for the children of the lowest gestational age, but strategies and success had greater associations with later function in those who were less premature.The results confirmed that children born very preterm in the first decade of the 2000’s still faced increased risks of developmental delays. Early visual tracking performance, and reaching for moving objects, were shown to be important visuomotor functions in the developmental process of children born very preterm. The studies in this thesis illustrate how early basic functions were related to different neurodevelopmental areas at a later stage and offer important new insights into developmental trajectories of children at risk of developmental impairments. These findings suggest that attention and predictive elements of adjusting one´s movements to motion, may be key mechanisms and possible targets in future intervention studies.
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| 5. |
- Kaul, Ylva F., et al.
(författare)
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Average 2.5-year neurodevelopmental test results in children born very preterm did not rule out cognitive deficits at 6.5 years of age
- 2021
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 110:3, s. 846-854
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Tidskriftsartikel (refereegranskat)abstract
- AimThe aim of the study was to investigate cognitive outcomes at 6.5 years in children born very preterm, in relation to neonatal characteristics and 2.5-year neurodevelopment.MethodsA prospective cohort, with gestational age 22.3-31.9 weeks, born 2004-2007, were examined at 2.5 years with the Bayley Scales of Infant and Toddler Development (Bayley-III) (n = 100) and at 6.5 years with the Wechsler Intelligence Scales (n = 91).ResultsNeonatal factors independently related to 6.5-year outcome were gestational age, retinopathy of prematurity and treated persistent ductus arteriosus. The Bayley-III cognitive scores explained only 44% of the Full-Scale Intelligence Quotient result at 6.5 years, and 22% of the children had Wechsler index results below −1 SD, indicating cognitive impairment, after average test results at 2.5 years. The relative risk to score below −1 SD on the Full-Scale IQ was 2.83 (95% CI 1.45-5.53) in children with gestational age below 28 weeks and 2.22 (95% CI 1.18-4.17) at gestational age 28-31 weeks.ConclusionVery preterm infants born in the 2000s had increased risks for impaired cognition at 6.5 years, but individual predictions based on neonatal risks and 2.5-year test results were not enough to identify all high-risk children.
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| 6. |
- Li, Y., et al.
(författare)
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Hyperoxia affects the regional pulmonary ventilation/perfusion ratio : an electrical impedance tomography study
- 2014
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 58:6, s. 716-725
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Tidskriftsartikel (refereegranskat)abstract
- Background The way in which hyperoxia affects pulmonary ventilation and perfusion is not fully understood. We investigated how an increase in oxygen partial pressure in healthy young volunteers affects pulmonary ventilation and perfusion measured by thoracic electrical impedance tomography (EIT). Methods Twelve semi-supine healthy male volunteers aged 21-36 years were studied while breathing room air and air-oxygen mixtures (FiO2) that resulted in predetermined transcutaneous oxygen partial pressures (tcPO2) of 20, 40 and 60kPa. The magnitude of ventilation (Zv) and perfusion (ZQ)-related changes in cyclic impedance variations, were determined using an EIT prototype equipped with 32 electrodes around the thorax. Regional changes in ventral and dorsal right lung ventilation (V) and perfusion (Q) were estimated, and V/Q ratios calculated. Results There were no significant changes in Zv with increasing tcPO2 levels. ZQ in the dorsal lung increased with increasing tcPO2 (P=0.01), whereas no such change was seen in the ventral lung. There was a simultaneous decrease in V/Q ratio in the dorsal region during hyperoxia (P=0.04). Two subjects did not reach a tcPO2 of 60kPa despite breathing 100% oxygen. Conclusion These results indicate that breathing increased concentrations of oxygen induces pulmonary vasodilatation in the dorsal lung even at small increases in FiO2. Ventilation remains unchanged. Local mismatch of ventilation and perfusion occurs in young healthy men, and the change in ventilation/perfusion ratio can be determined non-invasively by EIT.
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| 7. |
- Lundequist, Aiko, et al.
(författare)
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Executive function development in adolescents born very and extremely preterm
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Tidskriftsartikel (refereegranskat)abstract
- Executive function deficits are often reported as being a specific weakness in preterm born children. Yet, stability in function and development over time is largely unknown. In a prospective longitudinal study, 115 participants born very or extremely preterm, ≤ 31 weeks of gestation, participated in neuropsychological assessments at ages 5½ years and 18 years. Executive functions were separated into working memory and cognitive flexibility. Gestational age at birth, intrauterine growth, sex, perinatal medical complications, and parental education were tested as predictors, and developmental stability was investigated using Structural Equation Modeling. Working memory and cognitive flexibility were highly stable from preschool age to late adolescence. Higher parental education, higher gestational age, and female sex were related to better outcome at 5½ years which in turn fully mediated outcome at age 18 years. Perinatal medical complications and restricted intrauterine growth negatively influenced cognitive flexibility in late adolescence. The study poses an argument for identification of executive deficits before school entry among children born preterm, as such deficits are unlikely to diminish as a consequence of maturation.
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| 8. |
- Lundequist, Aiko, 1973-, et al.
(författare)
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Individual neuropsychological profiles at age 5 1/2 years in children born preterm in relation to medical risk factors
- 2013
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Ingår i: Child Neuropsychology. - : Informa UK Limited. - 0929-7049 .- 1744-4136. ; 19:3, s. 313-331
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Tidskriftsartikel (refereegranskat)abstract
- Follow-up studies of preterm children have reported a range of cognitive deficits, particularly in executive functions, visuospatial abilities, and learning. However, few researchers have adopted a person-oriented approach, exploring individual neuropsychological profiles. The aim of this study was to identify typical neuropsychological profiles among preterm children and control children, respectively. A second aim was to investigate if neuropsychological profiles at age 51/2 might be associated with perinatal medical risk factors. As part of the longitudinal Stockholm Neonatal Project, NEPSY for 4- to 7-year-old children (Korkman, 1990), WPPSI-R, and Movement ABC were administered at age 51/2 years to 145 preterm (mean gestational age 28 weeks) and 117 control children born at term. For the present study, the NEPSY results of each child were transformed into summary z scores for each of 5 neuropsychological domains: attention, memory, sensory-motor, verbal, and visuospatial functions. Subsequently, Ward's cluster analysis was performed for the preterm and control groups separately, identifying 5 neuropsychological profiles in both groups explaining around 56% and 57% of the variance, respectively. Overall, preterm children had lower neuropsychological results but also more diverging profiles compared to controls. The variability in outcome could not be sufficiently explained by birth weight, gestational age, or medical risks. The results suggest that prematurity interacts dynamically with genetic, medical, and environmental factors in neuropsychological development.
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| 9. |
- Lundequist, Aiko, 1973-
(författare)
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Longitudinal studies of executive and cognitive development after preterm birth
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stockholm Neonatal Project is a longitudinal population-based study of children born prematurely in 1988-93, with a very low birth weight (<1500 g), who have been followed prospectively from birth through adolescence. A matched control group was recruited at age 5 ½ years. The overall aim was to investigate long-term developmental outcome, paying particular attention to executive functions (EF) in relation to degree of prematurity, birth weight and medical risks. Study I showed a disadvantage in visuo-motor development at 5 ½ years, especially among the preterm boys. Visuo-motor skills were highly related to IQ, and also to EF. In Study II, neuropsychological profiles typical of preterm children and term born children, respectively, were identified through cluster analysis. The general level of performance corresponded well with IQ, motor functions and parental education in both groups, but preterm children had overall lower results and exhibited greater variability across domains. Study III showed that extremely preterm birth (w. 23-27) per se poses a risk for cognitive outcome at age 18, particularly for EF, and that perinatal medical complications add to the risk. By contrast, adolescents born very preterm (w. 28-31) performed just as well as term-born controls in all cognitive domains. However, adolescents born moderately preterm (w. 32-36) and small for gestational age showed general cognitive deficits. Study IV found that cognitive development was stable over time, with parental education and EF at 5 ½ years as significant predictors for cognitive outcome at age 18. Among preterm children, perinatal medical risks and being small for gestational age had a continued negative impact on cognitive development from 5 ½ to 18 years. Study V demonstrated that neuropsychological scoring of Bender drawings, developed in study I, predicted cognitive outcome in adolescence, indicating that the method may be useful in developmental screening around school entry.
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| 10. |
- Lundequist, Aiko, 1973-, et al.
(författare)
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Screening for executive dysfunction before school start : Concurrent and predictive validity of the Bender test
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: The aim of this study was to investigate if the Bender test, administered to late preschoolers and evaluated with a neuropsychological scoring system , can identify and predict executive dysfunctions at preschool age and in late adolescence, respectively.Participants and Methods: As part of the longitudinal Stockholm Neonatal Project, 134 adolescents born preterm with very low birth weight (< 1500g) and 94 matched controls born at term, participated in follow-up studies at ages 5 ½ and 18 years. On both occasions, the participants were assessed with an age appropriate intelligence test and tests of executive functions (EF) . Bender Visual Motor Gestalt Test was given at age 5 ½, and scored with ABC neuropsychological system. Stepwise regression analysis was used to investigate how cognitive outcome at age 18 was predicted by the Bender ABC score and EF at age 5 ½, gender, medical risk, birth weight ratio, and parental education. The validity of the Bender ABC neuropsychological score in screening for executive dysfunction was evaluated by Receiver Operating Characteristics-analysis (ROC).Results: Bender ABC neuropsychological scores predicted general intelligence and EF at 18 years almost as well as a more comprehensive battery, in both groups. ROC analysis showed that the Bender ABC had good diagnostic and predictive validity for identifying executive dysfunctions, with AUC-values of .84 in both cases.Conclusion: Bender with ABC neuropsychological scoring is a promising screening instrument for identifying executive dysfunctions before school start.
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| 11. |
- Lundequist, Aiko, 1973-, et al.
(författare)
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The Stockholm Neonatal Project : Stability and prediction of cognitive outcome from preschool age through adolescence in children born preterm
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate the stability of development in general intelligence (IQ) and executive functions (EF), and to identify predictors of cognitive development from preschool age through adolescence, in a cohort of preterm and term-born children.Participants and Methods: As part of the longitudinal Stockholm Neonatal Project, 134 adolescents born preterm with very low birth weight (< 1500g) and 94 matched controls born at term, participated in follow-up studies at ages 5 ½ and 18 years. On both occasions, the participants were assessed with an age appropriate Wechsler IQ test and tests of executive functions (EF). Stability in cognitive outcome was tested with Pearson correlations. Stepwise regression analyses were used to investigate how cognitive outcome at age 18 was predicted by EF at age 5 ½, parental education, gender, medical risk, and birth weight ratio.Results: IQ was quite stable form preschool age through adolescence (r =.78 in whole group, r = .84 in preterm and r= .61 in controls), as were EF (r = .65 in whole group, r = .64 in preterm and r = .53 in controls). In controls, EF at age 5 ½ and parental education predicted IQ (R² = .205) and EF at 18 years (R² = .249). In the preterm group, EF at age 5 ½, parental education, medical risks and birth weight ratio predicted IQ 18 years (R² = .508), and EF at age 5 ½ and medical risks predicted EF at18 years (R² = .432).Conclusions: Stability in cognitive outcomes from preschool through adolescence was high, particularly in the preterm group. EF at 5 ½ strongly predicted cognitive and executive functions at 18 years, in both groups. Over the same period, parental education had a continued positive effect on cognitive development. Among preterm children, perinatal medical risks predicted a less favorable continued cognitive development, especially in EF, and a low birth-weight ratio had a negative impact on general intelligence.
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| 12. |
- Nagy, Zoltan, et al.
(författare)
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Structural Correlates of Preterm Birth in the Adolescent Brain
- 2009
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Ingår i: Pediatrics. - : American Academy of Pediatrics. - 0031-4005 .- 1098-4275. ; 124:5, s. e964-e972
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The Stockholm Neonatal Project involves a prospective,cross-sectional, population-based, cohort monitored for 12 to17 years after birth; it was started with the aim of investigatingthe long-term structural correlates of preterm birth and comparingfindings with reports on similar cohorts.METHODS: High-resolution anatomic and diffusion tensor imagingdata measuring diffusion in 30 directions were collected byusing a 1.5-T MRI scanner. A total of 143 adolescents (12.18–17.7years of age) participated in the study, including 74 formerlypreterm infants with birth weights of 1500 g (range: 645–1486g) and 69 term control subjects. The 2 groups were well matchedwith respect to demographic and socioeconomic data. The anatomicMRI data were used for calculation of total brain volumes andvoxelwise comparison of gray matter (GM) volumes. The diffusiontensor imaging data were used for voxelwise comparison of whitematter (WM) microstructural integrity.RESULTS: The formerly preterm individuals possessed 8.8% smallerGM volume and 9.4% smaller WM volume. The GM and WM volumesof individuals depended on gestational age and birth weight.The reduction in GM could be attributed bilaterally to the temporallobes, central, prefrontal, orbitofrontal, and parietal cortices,caudate nuclei, hippocampi, and thalami. Lower fractional anisotropywas observed in the posterior corpus callosum, fornix, and externalcapsules.CONCLUSIONS: Although preterm birth was found to be a risk factorregarding long-term structural brain development, the outcomewas milder than in previous reports. This may be attributableto differences in social structure and neonatal care practices.
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| 13. |
- Petursdottir, Dyrleif, et al.
(författare)
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Visual-motor functions are affected in young adults who were born premature and screened for retinopathy of prematurity.
- 2021
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 110:1, s. 127-133
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess visual-motor integration in young adults previously included in a prospective study on the incidence of retinopathy of prematurity (ROP).METHODS: The study encompassed 59 preterm individuals, born 1988-1990, with a birth weight ≤1500 g, and 44 full-term controls, aged 25-29 years. Ophthalmological examination, including visual acuity and contrast sensitivity, and the Beery Visual-Motor Integration (VMI) with supplemental tests of visual perception and motor coordination, were performed. A short questionnaire was filled in.RESULTS: The preterm individuals had significantly lower scores than the controls in all VMI tests, median values and interquartile ranges: Beery VMI 87 (21) vs 103 (11), visual perception 97 (15) vs 101 (8) and motor coordination 97 (21) vs 102 (15), respectively. Within the preterm group, no correlations were found between the VMI tests and ROP, gestational age, birth weight or visual acuity. Contrast sensitivity was correlated to visual perception. Neurological complication at 2.5 years was a risk factor for lower scores on Beery VMI. The preterm subjects reported six times as many health problems as compared to the controls.CONCLUSION: Being born preterm seemed to have life-long effects. This study shows that visual-motor integration was affected in young adults born preterm.
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| 14. |
- Stålnacke, Johanna, et al.
(författare)
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A longitudinal model of executive function development from birth through adolescence in children born very or extremely preterm
- 2019
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Ingår i: Child Neuropsychology. - : Informa UK Limited. - 0929-7049 .- 1744-4136. ; 25:3, s. 318-335
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Tidskriftsartikel (refereegranskat)abstract
- Executive function deficits are often reported as a specific weakness in preterm children. Yet, executive function development is still not fully understood. In a prospective longitudinal study, 115 preterm born children, <= 31 weeks of gestation, were recruited at birth and subject to neuropsychological assessments at ages 5.5 and 18 years. By applying Miyake and colleagues' integrative framework of executive function to our data, two core components of executive function, working memory and cognitive flexibility, were identified through confirmatory factor analysis. Developmental stability was investigated in a serial multiple mediator structural equation model. Biological, medical, and social factors as well as mental development at 10 months were entered as predictors. Both components of executive function were highly stable from 5.5 to 18 years. Gestational age, intrauterine growth, lack of perinatal medical complications, and female sex were positively related to mental development at 10 months, which together with parental education influenced both core executive functions at 5.5 years. Working memory at 5.5 years mediated outcome in working memory at 18 years. In addition to the mediation of cognitive flexibility at 5.5 years, perinatal medical complications and restricted intrauterine growth had a continued direct negative impact on cognitive flexibility at 18 years. The application of a theoretical framework added to our understanding of executive function development in preterm born children. The study supports early identification of executive deficits among children born preterm, as deficits are unlikely to diminish with maturation.
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| 15. |
- Stålnacke, Johanna, 1967-, et al.
(författare)
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Individual cognitive patterns and developmental trajectories after preterm birth
- 2015
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Ingår i: Child Neuropsychology. - : Informa UK Limited. - 0929-7049 .- 1744-4136. ; 21:5, s. 648-667
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Tidskriftsartikel (refereegranskat)abstract
- Cognitive outcome after preterm birth is heterogeneous, and group level analyses may disguise individual variability in development. Using a person-oriented approach, this study investigated individual cognitive patterns and developmental trajectories from preschool age to late adolescence. As part of a prospective longitudinal study, 118 adolescents born preterm, with a birth weight <1,500 g, participated in neuropsychological assessments at age 5½ years and at 18 years. At each age, four cognitive indices, two tapping general ability and two tapping executive functions, were formed to reflect each individual’s cognitive profile. Cluster analyses were performed at each age separately, and individual movements between clusters across time were investigated. At both 5½ and 18 years, six distinct, and similar, cognitive patterns were identified. Executive functions were a weakness for some but not all subgroups, and verbal ability was a strength primarily among those whose overall performance fell within the normal range. Overall, cognitive ability at 5½ years was highly predictive of ability at age 18. Those who performed at low levels at 5½ did not catch-up, but rather deteriorated in relative performance. Over half of the individuals who performed above norm at 5½ years improved their relative performance by age 18. Among those performing around norm at 5½ years, half improved their relative performance over time, whereas the other half faced increased problems, indicating a need for further developmental monitoring. Perinatal factors were not conclusively related to outcome, stressing the need for cognitive follow-up assessment of the preterm born child before school entry.
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| 16. |
- Westrup, Björn, et al.
(författare)
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Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)
- 2004
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 93:4, s. 498-507
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to exert a positive impact on the development of prematurely born infants. The aim of the present investigation was to determine the effect of such care on the development at preschool age of children born with a gestational age of less than 32 wk. Methods: All surviving infants in a randomised controlled trial with infants born at a postmenstrual age less than 32 wk (11 in the NIDCAP group and 15 in the control group) were examined at 66.3 (6.0) mo corrected for prematurity [mean (SD)]. In the assessment we employed the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) for cognition, Movement Assessment Battery for Children (Movement ABC) for motor function, subtests of the NEPSY test battery for attention and distractibility, and the WHO definitions of impairment, disability and handicap. Exact binary logistic regression was employed. Results: There were no significant differences between the intervention group in Full-Scale IQ 93.4 (14.2) [mean (SD)] versus the control group 89.6 (27.2), Verbal IQ 93.6 (16.4) versus 93.7 (26.8) or Performance IQ 94.3 (14.7) versus 86.3 (24.8). In the NIDCAP group 8/13 (62%) survived without disability and for the children with conventional care this ratio was 7/19 (37%). The corresponding ratios for surviving without mental retardation were 10/13 (77%) and 11/19 (58%), and for surviving without attention deficits 10/13 (77%) and 10/19 (53%). Overall, the differences were not statistically significant, although the odds ratio for surviving with normal behaviour was statistical significant after correcting for group imbalances in gestational age, gender, growth retardation and educational level of the parents. Conclusion: Our trial suggests a positive impact by NIDCAP on behaviour at preschool age in a sample of infants born very prematurely. However, due to problems of recruitment less than half of the anticipated subjects were included in the study, which implies a low power and calls for caution in interpreting our findings. Larger trials in different cultural contexts are warranted.
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