Meta-Analysis of Neurobehavioral Outcomes in Very Preterm and/or Very Low Birth Weight Children

Sequelae of academic underachievement, behavioral problems, and poor executive function (EF) have been extensively reported for very preterm (

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Veröffentlicht in:Pediatrics (Evanston) 2009-08, Vol.124 (2), p.717-728
Hauptverfasser: Aarnoudse-Moens, Cornelieke Sandrine Hanan, Weisglas-Kuperus, Nynke, van Goudoever, Johannes Bernard, Oosterlaan, Jaap
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container_title Pediatrics (Evanston)
container_volume 124
creator Aarnoudse-Moens, Cornelieke Sandrine Hanan
Weisglas-Kuperus, Nynke
van Goudoever, Johannes Bernard
Oosterlaan, Jaap
description Sequelae of academic underachievement, behavioral problems, and poor executive function (EF) have been extensively reported for very preterm (
doi_str_mv 10.1542/peds.2008-2816
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Great variability in the published results, however, hinders the field in studying underlying dysfunctions and developing intervention strategies. We conducted a quantitative meta-analysis of studies published between 1998 and 2008 on academic achievement, behavioral functioning, and EF with the aim of providing aggregated measures of effect size for these outcome domains. Suitable for inclusion were 14 studies on academic achievement, 9 studies on behavioral problems, and 12 studies on EF, which compared a total of 4125 very preterm and/or VLBW children with 3197 term-born controls. Combined effect sizes for the 3 outcome domains were calculated in terms of Cohen's d. Q-test statistics were performed to test homogeneity among the obtained effect sizes. Pearson's correlation coefficients were calculated to examine the impact of mean birth weight and mean gestational age, as well as the influence of mean age at assessment on the effect sizes for academic achievement, behavioral problems, and EF. Combined effect sizes show that very preterm and/or VLBW children score 0.60 SD lower on mathematics tests, 0.48 SD on reading tests, and 0.76 SD on spelling tests than term-born peers. Of all behavioral problems stacked, attention problems were most pronounced in very preterm and/or VLBW children, with teacher and parent ratings being 0.43 to 0.59 SD higher than for controls, respectively. Combined effect sizes for parent and teacher ratings of internalizing behavior problems were small (&lt;0.28) and for externalizing behavior problems negligible (&lt;0.09) and not significant. Combined effect sizes for EF revealed a decrement of 0.57 SD for verbal fluency, 0.36 SD for working memory, and 0.49 SD for cognitive flexibility in comparison to controls. Mean age at assessment was not correlated with the strength of the effect sizes. Mathematics and reading performance, parent ratings of internalizing problems, teacher ratings of externalizing behavior, and attention problems, showed strong and positive correlations with mean birth weight and mean gestational age (all r values &gt; 0.51). Very preterm and/or VLBW children have moderate-to-severe deficits in academic achievement, attention problems, and internalizing behavioral problems and poor EF, which are adverse outcomes that were strongly correlated to their immaturity at birth. 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Andrology. Obstetrics ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Infant, Premature, Diseases - diagnosis ; Infant, Premature, Diseases - epidemiology ; Infant, Very Low Birth Weight ; Internal-External Control ; Learning Disorders - diagnosis ; Learning Disorders - epidemiology ; Longitudinal Studies ; Low birth weight ; Medical sciences ; Meta-analysis ; Miscellaneous ; Neurologic Examination - statistics &amp; numerical data ; Neuropsychological Tests - statistics &amp; numerical data ; Patient outcomes ; Pediatrics ; Pregnancy. Fetus. Placenta ; Psychometrics - statistics &amp; numerical data ; Public health. Hygiene ; Public health. 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Great variability in the published results, however, hinders the field in studying underlying dysfunctions and developing intervention strategies. We conducted a quantitative meta-analysis of studies published between 1998 and 2008 on academic achievement, behavioral functioning, and EF with the aim of providing aggregated measures of effect size for these outcome domains. Suitable for inclusion were 14 studies on academic achievement, 9 studies on behavioral problems, and 12 studies on EF, which compared a total of 4125 very preterm and/or VLBW children with 3197 term-born controls. Combined effect sizes for the 3 outcome domains were calculated in terms of Cohen's d. Q-test statistics were performed to test homogeneity among the obtained effect sizes. Pearson's correlation coefficients were calculated to examine the impact of mean birth weight and mean gestational age, as well as the influence of mean age at assessment on the effect sizes for academic achievement, behavioral problems, and EF. Combined effect sizes show that very preterm and/or VLBW children score 0.60 SD lower on mathematics tests, 0.48 SD on reading tests, and 0.76 SD on spelling tests than term-born peers. Of all behavioral problems stacked, attention problems were most pronounced in very preterm and/or VLBW children, with teacher and parent ratings being 0.43 to 0.59 SD higher than for controls, respectively. Combined effect sizes for parent and teacher ratings of internalizing behavior problems were small (&lt;0.28) and for externalizing behavior problems negligible (&lt;0.09) and not significant. Combined effect sizes for EF revealed a decrement of 0.57 SD for verbal fluency, 0.36 SD for working memory, and 0.49 SD for cognitive flexibility in comparison to controls. Mean age at assessment was not correlated with the strength of the effect sizes. Mathematics and reading performance, parent ratings of internalizing problems, teacher ratings of externalizing behavior, and attention problems, showed strong and positive correlations with mean birth weight and mean gestational age (all r values &gt; 0.51). Very preterm and/or VLBW children have moderate-to-severe deficits in academic achievement, attention problems, and internalizing behavioral problems and poor EF, which are adverse outcomes that were strongly correlated to their immaturity at birth. During transition to young adulthood these children continue to lag behind term-born peers.</description><subject>Academic achievement</subject><subject>Academic underachievement</subject><subject>Achievement</subject><subject>Adolescent</subject><subject>Attention Deficit Disorder with Hyperactivity - diagnosis</subject><subject>Attention Deficit Disorder with Hyperactivity - epidemiology</subject><subject>Biological and medical sciences</subject><subject>Birth weight</subject><subject>Birth weight, Low</subject><subject>Brain Damage, Chronic - diagnosis</subject><subject>Brain Damage, Chronic - epidemiology</subject><subject>Child</subject><subject>Child Behavior Disorders - diagnosis</subject><subject>Child Behavior Disorders - epidemiology</subject><subject>Child psychopathology</subject><subject>Child, Preschool</subject><subject>Childhood mental disorders</subject><subject>Children &amp; youth</subject><subject>Cognition Disorders - diagnosis</subject><subject>Cognition Disorders - epidemiology</subject><subject>Cross-Sectional Studies</subject><subject>Demographic aspects</subject><subject>Developmental Disabilities - diagnosis</subject><subject>Developmental Disabilities - epidemiology</subject><subject>Diseases of mother, fetus and pregnancy</subject><subject>Executive function (Psychology)</subject><subject>General aspects</subject><subject>Gestational Age</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Extremely Low Birth Weight</subject><subject>Infant, Newborn</subject><subject>Infant, Premature, Diseases - diagnosis</subject><subject>Infant, Premature, Diseases - epidemiology</subject><subject>Infant, Very Low Birth Weight</subject><subject>Internal-External Control</subject><subject>Learning Disorders - diagnosis</subject><subject>Learning Disorders - epidemiology</subject><subject>Longitudinal Studies</subject><subject>Low birth weight</subject><subject>Medical sciences</subject><subject>Meta-analysis</subject><subject>Miscellaneous</subject><subject>Neurologic Examination - statistics &amp; numerical data</subject><subject>Neuropsychological Tests - statistics &amp; numerical data</subject><subject>Patient outcomes</subject><subject>Pediatrics</subject><subject>Pregnancy. Fetus. Placenta</subject><subject>Psychometrics - statistics &amp; numerical data</subject><subject>Public health. Hygiene</subject><subject>Public health. 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Andrology. Obstetrics</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Extremely Low Birth Weight</topic><topic>Infant, Newborn</topic><topic>Infant, Premature, Diseases - diagnosis</topic><topic>Infant, Premature, Diseases - epidemiology</topic><topic>Infant, Very Low Birth Weight</topic><topic>Internal-External Control</topic><topic>Learning Disorders - diagnosis</topic><topic>Learning Disorders - epidemiology</topic><topic>Longitudinal Studies</topic><topic>Low birth weight</topic><topic>Medical sciences</topic><topic>Meta-analysis</topic><topic>Miscellaneous</topic><topic>Neurologic Examination - statistics &amp; numerical data</topic><topic>Neuropsychological Tests - statistics &amp; numerical data</topic><topic>Patient outcomes</topic><topic>Pediatrics</topic><topic>Pregnancy. Fetus. Placenta</topic><topic>Psychometrics - statistics &amp; numerical data</topic><topic>Public health. Hygiene</topic><topic>Public health. 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Great variability in the published results, however, hinders the field in studying underlying dysfunctions and developing intervention strategies. We conducted a quantitative meta-analysis of studies published between 1998 and 2008 on academic achievement, behavioral functioning, and EF with the aim of providing aggregated measures of effect size for these outcome domains. Suitable for inclusion were 14 studies on academic achievement, 9 studies on behavioral problems, and 12 studies on EF, which compared a total of 4125 very preterm and/or VLBW children with 3197 term-born controls. Combined effect sizes for the 3 outcome domains were calculated in terms of Cohen's d. Q-test statistics were performed to test homogeneity among the obtained effect sizes. Pearson's correlation coefficients were calculated to examine the impact of mean birth weight and mean gestational age, as well as the influence of mean age at assessment on the effect sizes for academic achievement, behavioral problems, and EF. Combined effect sizes show that very preterm and/or VLBW children score 0.60 SD lower on mathematics tests, 0.48 SD on reading tests, and 0.76 SD on spelling tests than term-born peers. Of all behavioral problems stacked, attention problems were most pronounced in very preterm and/or VLBW children, with teacher and parent ratings being 0.43 to 0.59 SD higher than for controls, respectively. Combined effect sizes for parent and teacher ratings of internalizing behavior problems were small (&lt;0.28) and for externalizing behavior problems negligible (&lt;0.09) and not significant. Combined effect sizes for EF revealed a decrement of 0.57 SD for verbal fluency, 0.36 SD for working memory, and 0.49 SD for cognitive flexibility in comparison to controls. Mean age at assessment was not correlated with the strength of the effect sizes. Mathematics and reading performance, parent ratings of internalizing problems, teacher ratings of externalizing behavior, and attention problems, showed strong and positive correlations with mean birth weight and mean gestational age (all r values &gt; 0.51). Very preterm and/or VLBW children have moderate-to-severe deficits in academic achievement, attention problems, and internalizing behavioral problems and poor EF, which are adverse outcomes that were strongly correlated to their immaturity at birth. During transition to young adulthood these children continue to lag behind term-born peers.</abstract><cop>Elk Grove Village, IL</cop><pub>Am Acad Pediatrics</pub><pmid>19651588</pmid><doi>10.1542/peds.2008-2816</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record>
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subjects Academic achievement
Academic underachievement
Achievement
Adolescent
Attention Deficit Disorder with Hyperactivity - diagnosis
Attention Deficit Disorder with Hyperactivity - epidemiology
Biological and medical sciences
Birth weight
Birth weight, Low
Brain Damage, Chronic - diagnosis
Brain Damage, Chronic - epidemiology
Child
Child Behavior Disorders - diagnosis
Child Behavior Disorders - epidemiology
Child psychopathology
Child, Preschool
Childhood mental disorders
Children & youth
Cognition Disorders - diagnosis
Cognition Disorders - epidemiology
Cross-Sectional Studies
Demographic aspects
Developmental Disabilities - diagnosis
Developmental Disabilities - epidemiology
Diseases of mother, fetus and pregnancy
Executive function (Psychology)
General aspects
Gestational Age
Gynecology. Andrology. Obstetrics
Humans
Infant
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature, Diseases - diagnosis
Infant, Premature, Diseases - epidemiology
Infant, Very Low Birth Weight
Internal-External Control
Learning Disorders - diagnosis
Learning Disorders - epidemiology
Longitudinal Studies
Low birth weight
Medical sciences
Meta-analysis
Miscellaneous
Neurologic Examination - statistics & numerical data
Neuropsychological Tests - statistics & numerical data
Patient outcomes
Pediatrics
Pregnancy. Fetus. Placenta
Psychometrics - statistics & numerical data
Public health. Hygiene
Public health. Hygiene-occupational medicine
Reference Values
Risk Factors
Statistics as Topic
title Meta-Analysis of Neurobehavioral Outcomes in Very Preterm and/or Very Low Birth Weight Children
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