Babies born preterm – at any degree – have a greater risk of developing cognitive, motor and behavioural difficulties and these problems persist throughout school years, finds a new study published online in BJOG: An International Journal of Obstetrics and Gynaecologists.
The authors call for “organisations delivering healthcare, policy makers and educational institutions to take into account the additional academic, emotional and behavioural needs of children born preterm.”
In the UK, around 60,000 babies are born prematurely each year. Short term complications of preterm for the child include higher risk of respiratory complications, sepsis, and bleeding into brain. In addition, these children are at risk of cognitive, motor, and behavioural difficulties in the long-term.
However, there is little evidence on the effects of being born preterm at various points in subsequent years after birth. Therefore, UK based researchers carried out a systematic review to analyse the effect of preterm birth at various stages on the cognitive, motor, behavioural and academic performance of children born preterm versus those born at term.
The analysis involved 74 studies, of 64,061 children, that reported neurodevelopmental outcomes from 2 years of age in children born preterm compared with a group of term-born children between 1980-2016.
It compared children born preterm, including very (<28 weeks), moderately (28–33+6 weeks) and late (34–36+6 weeks) preterm gestations with term newborns (≥37 weeks) at various stages: 2–4 years (preschool), >4–11 years (primary school), >11–18 years (secondary school) and >18 years (higher education).
The results show preterm children had lower cognitive scores on a range of IQ tests and in motor skills, behaviour, reading, mathematics and spelling at primary school age, and this remained through to secondary school age, except for mathematics.
In addition, children born preterm were twice as likely to be diagnosed with ADHD than term-born children.
Furthermore, preterm children lagged behind term peers in working memory and processing speed and this persisted after school age, with possible adverse effects on academic achievement.
Children born at the lowest gestations were most at risk of cognitive impairment, but moderate preterm children born between 28-34 weeks also performed almost as poorly as those born before 28 weeks.
Prof Shakila Thangaratinam, from Barts Research Centre for Women’s Health (BARC) at Queen Mary University of London, and lead author of the study, said:
‘Our work demonstrates that the developmental effects of prematurity persist beyond immediate childhood. Individuals, organisations and services involved in the long term care of children should take gestational age at delivery into account while making assessments, and in management decisions.’
Dr Javier Zamora, senior lecturer in women’s health at Queen Mary University of London, and corresponding author of the study, said:
“These findings highlight the crucial need for parents, caregivers and teachers to recognise the need for support in social, academic and behavioural aspects at primary and secondary school ages for children born preterm. The overall development of the child is dependent on the support provided to maximise their potential.”
Mr Edward Morris, Vice President of the Royal College of Obstetricians and Gynaecologists, said:
“These results show children born prematurely have a higher risk of a number of developmental problems. It is important for the effect of a preterm birth on the neurodevelopment of children to be included in counselling for parents who expect or have had a preterm delivery. Likewise, any decision on the timing of delivery should take into consideration the long term effects of prematurity.”
Dr Michael Marsh, Consultant Obstetrician and Gynaecologist and Deputy Editor of BJOG, said:
“It is well known that babies born preterm are at risk of developmental difficulties, but there is no simple or easy way to predict long term outcomes. For the first time, this study provides risk of developing such problems at various points in the child’s life.”
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Article: Cognitive, motor, behavioural and academic performances of children born preterm: a meta analysis and systematic review involving 64,061 children
BJOG 2017: DOI: 10.1111/1471-0528.14832
Article link: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14832/full
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