Neuropsychological and Behavioral Outcomes of Extremely Low Birth Weight at Age Three

Abstract

Preterm (PT) birth is an established risk factor for high mortality and morbidity rates. Infants and school-aged children have been well-studied, but few have described neuropsychological and behavioral outcomes at preschool age. We compared a 2004–2006 preterm/extremely low birth weight (ELBW) cohort (PT/ELBW; N = 60) born ≤33 weeks gestation and <1,000 g with term-born participants (N = 90) at age 3. PT/ELBW subgroups (<26 weeks; 26–33 weeks) performed more poorly than the term-born group on verbal, nonverbal, fine motor, visual-motor, visual attention, noun fluency, early number concepts, and functional communication measures prior to age correction; PT/ELBW children born <26 weeks additionally performed more poorly on action-verb fluency. Those born 26–33 weeks had executive and adaptive deficits on parental behavioral report. Age correction significantly improved preterm scores without masking relative verbal, nonverbal, motor, and behavioral weaknesses that may require early intervention. In conclusion, subtle delays in emergent neuropsychological and behavioral functions are measurable at age 3, and neurobiological immaturity remains a prepotent influence on outcome in the preschool years. Further study should enhance our understanding of the trajectory of brain development and the limits of neuroplasticity in these highly at-risk children.

ACKNOWLEDGMENTS

We acknowledge the invaluable assistance of Donna Long, Rebecca Q. Beck, Kelly Coulehan Crotty, Elyssa Scharaga, and Sarah Doyle, and the support of Margaret Snyder.

Notes

None of the authors had financial or other relationships that could be interpreted as conflicts of interests relevant to the content of this article.

This research was supported by an Inova Health Systems Faculty Grant awarded to the senior author (ISB), and by the Maggie Snyder Foundation for the Premature and Pediatric Pulmonary Patient of Falls Church, VA.