Antenatal and Neonatal Antecedents of Executive Dysfunctions in Extremely Preterm Children

Abstract

To find out why children born extremely preterm are at heightened risk of executive dysfunctions, the authors assessed 716 children who were 10 years old born extremely preterm whose IQ was ≥ 70. A working memory dysfunction (n = 169), an inhibition dysfunction (n = 360), a switching dysfunction (355), and all 3 (executive dysfunction; n = 107) were defined on the basis of Z-scores ≤ -1 on the Differential Ability Scales-II Working Memory composite, and/or on the NEPSY-II Inhibition-Inhibition and Inhibition-Switching subtests. All risk profiles include an indicator of socioeconomic disadvantage. The risk profile of each of the 3 individual dysfunctions includes an indicator of the newborn's immaturity, and the risk profiles of the inhibition dysfunction and switching dysfunction also include an indicator of inflammation. Only the switching dysfunction was associated with fetal growth restriction. The risk factors for executive dysfunction can be subsumed under the 4 themes of socioeconomic disadvantage, immaturity/vulnerability, inflammation, and fetal growth restriction.

Neurobehavioral Phenotype and Dysexecutive Syndrome of Preterm Children: Comorbidity or Trigger? An Update

“…This difference is stronger at the youngest GA and worsens over time for WM [ 15 , 18 , 29 , 30 ]. Risk factors for VPs’ executive deficits can be summarized into four categories, namely, immaturity (weeks of GA), growth restriction, perinatal inflammation/infection and socioeconomic disadvantages [ 31 ]. EF deficits are also reported by parents and teachers in preterm infants and appear to persist over time [ 32 , 33 , 34 ].…”

Placental programming, perinatal inflammation, and neurodevelopment impairment among those born extremely preterm

“…28,[154][155][156][157][158][159][160][161][162][163][164] Indicators of mother's low SES that are associated with an increased risk of executive dysfunctions include young age at the time of the delivery, not married, low level of educational achievement, eligibility for government-provided medical-care insurance, and smoking cigarettes during pregnancy. 165 Low education status at time of birth is also associated with substantial neurodevelopmental impairment with scores ≥2 standard deviations below normative expectation. 155 Conversely, maternal educational advancement in child's first 10 years of life is associated with modestly improved neurocognitive outcomes, even when adjusting for confounders, including gestational age, fetal growth restriction, maternal IQ, and minority ethnic/racial status.…”

A Consideration of Racism in Pediatric Epidemiologic Studies

“…We have been guilty of this in a number of our own studies. 4,5 In the context of growing efforts to confront and dismantle racism in US society, including racism in healthcare research, 6,7 we wish to re-sensitize clinical epidemiologicchild health researchers to the implications of using race as a covariate (ie, not the primary focus of antecedent risk) in analyses.…”