26 Feb Despite Advancing Neonatal Health, Preterm Babies Still Risk Cognitive Impairment
MedicalResearch.com Interview with:
Sabrina Twilhaar, MS, PhD candidate
Child Study Group, sectie Klinische Neuropsychologie
Vrije Universiteit Amsterdam
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It is well-known that preterm birth has negative consequences for cognitive development.
During the early 1990s important progress in neonatal health care resulted in a considerable increase in the survival of preterm infants. Earlier meta-analyses showed large differences in intelligence between very preterm and full-term born children. However, these meta-analyses included mostly studies on children born before 1990. Because of the advances in neonatal health care since that time, it was important to update our knowledge on the outcomes of more recently born preterm infants. We combined the results of 71 studies, together including 7752 very preterm and 5155 full-term born children, and found a difference in intelligence between very preterm and full-term children that was still large.
Interestingly, despite advancing neonatal health care, we also found no indication of improvement in the cognitive outcomes of very preterm born children during the period from 1990 to 2008. In addition, we searched for factors that increase the risk for poor cognitive outcomes in these children and we found that children with a chronic lung disease that is amongst others caused by mechanical ventilation of the immature lungs are even more at risk for poor cognitive outcomes.
MedicalResearch.com: What should readers take away from your report?
Response: Our study indicates that improving the outcomes of very preterm born children remains a challenge. The findings emphasize the importance of developing prevention and intervention strategies to improve the outcomes of very preterm born children. Preventive strategies to reduce the incidence of bronchopulmonary dysplasia may be crucial to improve outcomes after extremely or very preterm birth.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Identifying those preterm born infants that are most at risk for adverse outcomes is an important challenge. Developmental outcomes are the result of complex interactions between biological factors and the environment. Research should take this into account and focus on both aspects and their interaction.
Long-term follow up of very preterm born children is highly important in this respect as this will increase our understanding of the specific problems preterm born children encounter during development and relate these to perinatal and sociodemographic factors that may subsequently be targeted by prevention and intervention strategies.
Currently, there is a great diversity of early intervention programs that are provided to very preterm born infants and their families in the first year of life, most of which are focused on the interaction between parents and their child. Overall, these interventions seem to have positive effects on cognitive outcomes at short term, but at long-term no effects are found and research is limited. It is generally assumed that children may benefit from early intervention and the earlier these interventions are provided the better, but it is yet unclear in what specific form and for which children. Although these interventions may help children to reach their full potential, the effects of very preterm birth and accompanying complications on the brain cannot be undone by these early interventions. Therefore, the most important way to improve long-term cognitive outcomes of preterm infants will be by preventing complications during the neonatal period and limiting the consequences of these complications for brain development. Our research showed a strong association between bronchopulmonary dysplasia and poor cognitive outcome in extremely and very preterm born children. This suggests that lowering the incidence of bronchopulmonary dysplasia may help to improve the cognitive outcomes of these children.
Twilhaar ES, Wade RM, de Kieviet JF, van Goudoever JB, van Elburg RM, Oosterlaan J. Cognitive Outcomes of Children Born Extremely or Very Preterm Since the 1990s and Associated Risk FactorsA Meta-analysis and Meta-regression. JAMA Pediatr. Published online February 19, 2018. doi:10.1001/jamapediatrics.2017.5323
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