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Observational Study
. 2019 May 3;2(5):e192914.
doi: 10.1001/jamanetworkopen.2019.2914.

Association of Socioeconomic Status and Brain Injury With Neurodevelopmental Outcomes of Very Preterm Children

Isabel Benavente-Fernández  1   2   3 , Anne Synnes  4 , Ruth E Grunau  4 , Vann Chau  1   2 , Chantel Ramraj  5   6 , Torin Glass  1   2 , Dalit Cayam-Rand  1   2 , Arjumand Siddiqi  5   6 , Steven P Miller  1   2   3
Affiliations
Observational Study

Association of Socioeconomic Status and Brain Injury With Neurodevelopmental Outcomes of Very Preterm Children

Isabel Benavente-Fernández et al. JAMA Netw Open. .

Abstract

Importance: Studies of socioeconomic status and neurodevelopmental outcome in very preterm neonates have not sensitively accounted for brain injury.

Objective: To determine the association of brain injury and maternal education with motor and cognitive outcomes at age 4.5 years in very preterm neonates.

Design, setting, and participants: Prospective cohort study of preterm neonates (24-32 weeks' gestation) recruited August 16, 2006, to September 9, 2013, at British Columbia Women's Hospital in Vancouver, Canada. Analysis of 4.5-year outcome was performed in 2018.

Main outcomes and measures: At age 4.5 years, full-scale IQ assessed using the Wechsler Primary and Preschool Scale of Intelligence, Fourth Edition, and motor outcome by the percentile score on the Movement Assessment Battery for Children, Second Edition.

Results: Of 226 survivors, neurodevelopmental outcome was assessed in 170 (80 [47.1%] female). Based on the best model to assess full-scale IQ accounting for gestational age, standardized β coefficients demonstrated the effect size of maternal education (standardized β = 0.21) was similar to that of white matter injury volume (standardized β = 0.23) and intraventricular hemorrhage (standardized β = 0.23). The observed and predicted cognitive scores in preterm children born to mothers with postgraduate education did not differ in those with and without brain injury. The best-performing model to assess for motor outcome accounting for gestational age included being small for gestational age, severe intraventricular hemorrhage, white matter injury volume, and chronic lung disease.

Conclusions and relevance: At preschool age, cognitive outcome was comparably associated with maternal education and neonatal brain injury. The association of brain injury with poorer cognition was attenuated in children born to mothers of higher education level, suggesting opportunities to promote optimal outcomes.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Benavente-Fernández reported grants from the Spanish Pediatric Society and the Spanish Neonatology Society during the conduct of the study. Drs Synnes, Grunau, Chau, and Miller reported grants from the Canadian Institute of Health Research during the conduct of the study. Dr Miller also reported research funding from Bloorview Children's Hospital Chair in Paediatric Neuroscience during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Distribution of Cognitive and Motor Scores at 4.5 Years by Maternal Level of Education
Distribution of cognitive (A) and motor (B) scores at age 4.5 years across the cohort divided by maternal level of education. The postgraduate group achieved a mean IQ and a median Movement Assessment Battery for Children (M-ABC2) score higher than the undergraduate degree group and primary or secondary school group (P = .01 and P = .02, respectively). Bars indicate the distribution of the studied variable for the whole cohort. Lines indicate the distribution of the studied variable by maternal level of education. WPPSI-IV indicates Wechsler Primary and Preschool Scale of Intelligence, Fourth Edition.
Figure 2.
Figure 2.. Estimated IQ in Neonates With and Without Brain Injury by Maternal Level of Education
Mean difference of IQ scores by groups of maternal level of education.
See this image and copyright information in PMC

Comment in

References

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