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Ment LR, Vohr B, Allan W, et al. Change in Cognitive Function Over Time in Very Low-Birth-Weight Infants. JAMA. 2003;289(6):705–711. doi:https://doi.org/10.1001/jama.289.6.705
Author Affiliations: Departments of Pediatrics (Dr Ment and Ms Schneider), Neurology (Dr Ment), Epidemiology and Public Health (Ms Katz and Dr Makuch), and Neurosurgery (Drs Westerveld and Duncan), Yale University School of Medicine, New Haven, Conn; Department of Pediatrics, Brown University School of Medicine, Providence, RI (Dr Vohr); and Department of Neurology, Maine Medical Center, Portland (Dr Allan).
Context Preterm very low-birth-weight (VLBW) infants have a high prevalence
of neurodevelopmental disability when evaluated during the first several years
of life. However, recent experimental data suggest that the developing brain
may recover from or compensate for injury.
Objective To determine if there is cognitive improvement throughout early and
middle childhood following VLBW birth.
Design, Setting, and Participants Follow-up data of 296 infants born weighing 600 to 1250 g who participated
in a prospective, randomized, placebo-controlled intraventricular hemorrhage
(IVH) prevention study performed at 3 northeastern US hospitals between September
1989 and August 1992 and who were serially evaluated at 36, 54, 72, and 96
months of corrected age (CA).
Main Outcome Measures The age-normed Peabody Picture Vocabulary Test–Revised (PPVT-R)
score and measures of intelligence.
Results Overall, the median PPVT-R score increased from 88 at 36 months of CA
to 99 at 96 months of CA; when data from 36 and 96 months of CA were compared,
45% of children gained 10 points or more and 12.5% showed a 5- to 9-point
increase in test scores. Similar findings were noted for full-scale and verbal
IQ scores. Multivariate analyses demonstrated that increasing age, residence
in a 2-parent household, and higher levels of maternal education were all
significantly associated with higher PPVT-R scores (for each, P<.001). In addition, early intervention led to greater increases
over time in PPVT-R scores among children whose mothers had less than a high
school education compared with those with a high school education level or
greater (P = .03 by test for interaction). Although
most children showed improvement in PPVT-R scores with increasing CA, children
with early-onset IVH and subsequent significant central nervous system injury
had the lowest PPVT-R scores initially and the scores declined over time (P = .009 by test for interaction).
Conclusions The majority of VLBW children had improvement in verbal and IQ test
scores over time. Only children with early-onset IVH followed by significant
central nervous system injury had low PPVT-R scores that declined over time.
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