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Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children.
- Source :
-
Pediatrics [Pediatrics] 2009 Aug; Vol. 124 (2), pp. 717-28. Date of Electronic Publication: 2009 Jul 27. - Publication Year :
- 2009
-
Abstract
- Objective: Sequelae of academic underachievement, behavioral problems, and poor executive function (EF) have been extensively reported for very preterm (<or=33 weeks' gestation) and/or very low birth weight (VLBW) (<or=1500 g) children. 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.<br />Methods: 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.<br />Results: 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 (<0.28) and for externalizing behavior problems negligible (<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 > 0.51).<br />Conclusions: 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.
- Subjects :
- Achievement
Adolescent
Attention Deficit Disorder with Hyperactivity diagnosis
Attention Deficit Disorder with Hyperactivity epidemiology
Brain Damage, Chronic epidemiology
Child
Child Behavior Disorders epidemiology
Child, Preschool
Cognition Disorders epidemiology
Cross-Sectional Studies
Developmental Disabilities epidemiology
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature, Diseases epidemiology
Internal-External Control
Learning Disabilities epidemiology
Longitudinal Studies
Neurologic Examination statistics & numerical data
Neuropsychological Tests statistics & numerical data
Psychometrics statistics & numerical data
Reference Values
Risk Factors
Statistics as Topic
Brain Damage, Chronic diagnosis
Child Behavior Disorders diagnosis
Cognition Disorders diagnosis
Developmental Disabilities diagnosis
Infant, Extremely Low Birth Weight
Infant, Premature, Diseases diagnosis
Infant, Very Low Birth Weight
Learning Disabilities diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1098-4275
- Volume :
- 124
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 19651588
- Full Text :
- https://doi.org/10.1542/peds.2008-2816