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Review
. 2019 Sep;61(9):1015-1024.
doi: 10.1111/dmcn.14213. Epub 2019 Apr 3.

Executive function deficits in children born preterm or at low birthweight: a meta-analysis

Carolien A van Houdt  1   2 , Jaap Oosterlaan  3   4 , Aleid G van Wassenaer-Leemhuis  1 , Anton H van Kaam  1   5 , Cornelieke S H Aarnoudse-Moens  1   2   3   6
Affiliations
Review

Executive function deficits in children born preterm or at low birthweight: a meta-analysis

Carolien A van Houdt et al. Dev Med Child Neurol. 2019 Sep.

Abstract
in English, Spanish, Portuguese

Aim: To investigate the magnitude of executive function deficits and their dependency on gestational age, sex, age at assessment, and year of birth for children born preterm and/or at low birthweight.

Method: PubMed, PsychINFO, Web of Science, and ERIC were searched for studies reporting on executive functions in children born preterm/low birthweight and term controls born in 1990 and later, assessed at a mean age of 4 years or higher. Studies were included if five or more studies reported on the same executive function measures.

Results: Thirty-five studies (3360 children born preterm/low birthweight, 2812 controls) were included. Children born preterm/low birthweight performed 0.5 standardized mean difference (SMD) lower on working memory and cognitive flexibility and 0.4 SMD lower on inhibition. SMDs for these executive functions did not significantly differ from each other. Meta-regression showed that heterogeneity in SMDs for working memory and inhibition could not be explained by study differences in gestational age, sex, age at assessment, or year of birth.

Interpretation: Children born preterm/low birthweight since 1990 perform half a SMD below term-born peers on executive function, which does not seem to improve with more recent advances in medical care or with increasing age.

What this paper adds: Children born preterm/low birthweight perform below term-born children on core executive functions. Lower gestational age or male sex are not risk factors for poorer executive functions. Executive function difficulties in children born preterm/low birthweight remain stable across childhood. Executive function difficulties are similar for children born recently and children born in earlier eras.

DÉFICIT EN FUNCIONES EJECUTIVAS EN NIÑOS NACIDOS PRETÉRMINO O CON BAJO PESO AL NACER: UN METAANÁLISIS: OBJETIVO: Investigar la magnitud del déficit de funciones ejecutivas y su dependencia de la edad gestacional, sexo, edad a la evaluación y año de nacimiento de los niños nacidos pretérmino y/o bajo peso al nacer.

Metodo: Se buscaron en PubMed, PsychINFO, Web of Science y ERIC estudios que reportaran las funciones ejecutivas de los niños nacidos pretérmino y/o bajo peso al nacer y en niños nacidos de término como controles nacidos en 1990 y posterior, evaluados a una edad media de 4 años o más. Los estudios se incluyeron si 5 o más estudios informaban sobre las mismas medidas de la función ejecutiva.

Resultados: Se incluyeron 35 estudios (3360 niños nacidos pretérmino y/o bajo peso al nacer, 2812 controles). Estos niños tuvieron una diferencia media estandarizada (DME) de 0.5 en la memoria de trabajo y la flexibilidad cognitiva y 0.4 en la inhibición de la DME. La DMEs en funciones ejecutivas no tuvieron diferencias significativas entre ellos. La meta-regresión mostró que la heterogeneidad de las DMEs para el trabajo de memoria y la inhibición no podría explicarse por la diferencia en la edad gestacional, sexo, edad a la evaluación o año de nacimiento.

Interpretacion: Los niños nacidos pretérmino y/o bajo peso al nacer desde 1990 realizan la mitad de un SMD por debajo de sus pares nacidos a término en la función ejecutiva, que no parece mejorar con los avances más recientes en la atención médica o con el aumento de la edad.

DEFICITS DA FUNÇÃO EXECUTIVA EM CRIANÇAS NASCIDAS PRÉ-TERMO OU COM BAIXO PESO AO NASCER: UMA METANÁLISE: OBJETIVO: Investigar a magnitude dos déficits da função executiva e sua dependência da idade gestacional, sexo, idade no momento da avaliação e ano de nascimento de crianças pré-termo e / ou baixo peso ao nascer. MÉTODO: PubMed, PsychINFO, Web of Science e ERIC foram pesquisados para estudos sobre funções executivas em crianças nascidas prematuras / com baixo peso ao nascer e controles a termo, nascidos em 1990 e anos posteriores, avaliados em uma idade média de 4 anos ou mais. Os estudos foram incluídos se 5 ou mais estudos relatassem as mesmas medidas de função executiva. RESULTADOS: Trinta e cinco estudos (3360 crianças nascidas pré-termo / baixo peso ao nascer, 2812 controles) foram incluídos. As crianças nascidas pré-termo / baixo peso ao nascer apresentaram uma diferença média padronizada (DMP) 0,5 menor na memória operacional e na flexibilidade cognitiva e DMP 0,4 menor na inibição. DMPs para essas funções executivas não diferiram significativamente entre si. Meta-regressão mostrou que a heterogeneidade em DMPs para memória de trabalho e inibição não pode ser explicada pelas diferenças de estudo em idade gestacional, sexo, idade na avaliação ou ano de nascimento. INTERPRETAÇÃO: Crianças nascidas pré-termo / baixo peso ao nascer desde 1990 realizam metade de um DMP abaixo de pares nascidos a termo em função executiva, o que não parece melhorar com os avanços mais recentes nos cuidados médicos ou com o aumento da idade.

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Figures

Figure 1
Figure 1
Forest plot of the studies on working memory. CI, confidence interval.
Figure 2
Figure 2
Forest plot of the studies on inhibition. CI, confidence interval.
Figure 3
Figure 3
Forest plot for studies on cognitive flexibility. CI, confidence interval.
Figure 4
Figure 4
(a) Meta‐regression of gestational age on working memory. (b) Meta‐regression of gestational age on working memory after excluding two outliers with gestational ages of 24.4 and 35.6 weeks respectively. [Colour figure can be viewed at http://www.wileyonlinelibrary.com/].
See this image and copyright information in PMC

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