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December 2015

Prognostic Factors for Poor Cognitive Development in Children Born Very Preterm or With Very Low Birth WeightA Systematic Review

Author Affiliations
  • 1National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England
  • 2Centre for Environmental and Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England
  • 3Institute of Women’s Health, University College London, London, England
JAMA Pediatr. 2015;169(12):1162-1172. doi:10.1001/jamapediatrics.2015.2175

Importance  Cognitive delay is the most common form of impairment among children born very preterm (VPT) at 32 weeks or less or with very low birth weight (VLBW) of 1250 g or less. It is important to identify factors that are robust predictors of long-term outcome because the ability to predict future prognosis will assist in health care and educational service planning and provision.

Objective  To identify prognostic factors for poor cognitive development in children born VPT or with VLBW.

Evidence Review  A systematic review was conducted using MEDLINE, EMBASE, and PyscINFO databases to identify studies published between January 1, 1990, and June 1, 2014, reporting multivariable prediction models for neurodevelopment in VPT or VLBW children. Thirty-one studies comprising 98 risk factor models for cognitive outcome were identified. Two independent reviewers extracted key information on study design, outcome definition, risk factor selection, model development, and reporting and conducted a risk-of-bias assessment.

Findings  There was evidence that male sex, nonwhite race/ethnicity, lower level of parental education, and lower birth weight were predictive of global cognitive impairment in children younger than 5 years. In older children, only the influence of parental education was sustained. Male sex was also predictive of language impairment in early infancy, but not in middle childhood. Gestational age was a poor predictor of cognitive outcome, probably because of a reduced discriminatory power in cohorts restricted to a narrow gestational age range. The prognostic value of neonatal brain injury was unclear; however, studies adopted mixed strategies for managing children with physical or neurosensory disability.

Conclusions and Relevance  The influence of perinatal risk factors on cognitive development of VPT or VLBW children appears to diminish over time as environmental factors become more important. It is difficult to isolate cognitive outcomes from motor and neurosensory impairment, and the strategy for dealing with untestable children has implications for risk prediction.