Meta-Analysis of Neurobehavioral Outcomes in Very Preterm and/or Very Low Birth Weight Children
Open accessAbstract
OBJECTIVE: Sequelae of academic underachievement, behavioral problems, and poor executive function (EF) have been extensively reported for very preterm (≤33 weeks' gestation) and/or very low birth weight (VLBW) (≤1500 g) children. Great variability in the published results, however, hinders the field in studying underlying dysfunctions and developing intervention strategies. We conducted a quantitative meta-analysis of studies published between 1998 and 2008 on academic achievement, behavioral functioning, and EF with the aim of providing aggregated measures of effect size for these outcome domains. METHODS: Suitable for inclusion were 14 studies on academic achievement, 9 studies on behavioral problems, and 12 studies on EF, which compared a total of 4125 very preterm and/or VLBW children with 3197 term-born controls. Combined effect sizes for the 3 outcome domains were calculated in terms of Cohen's d. Q-test statistics were performed to test homogeneity among the obtained effect sizes. Pearson's correlation coefficients were calculated to examine the impact of mean birth weight and mean gestational age, as well as the influence of mean age at assessment on the effect sizes for academic achievement, behavioral problems, and EF. RESULTS: Combined effect sizes show that very preterm and/or VLBW children score 0.60 SD lower on mathematics tests, 0.48 SD on reading tests, and 0.76 SD on spelling tests than term-born peers. Of all behavioral problems stacked, attention problems were most pronounced in very preterm and/or VLBW children, with teacher and parent ratings being 0.43 to 0.59 SD higher than for controls, respectively. Combined effect sizes for parent and teacher ratings of internalizing behavior problems were small (<0.28) and for externalizing behavior problems negligible (<0.09) and not significant. Combined effect sizes for EF revealed a decrement of 0.57 SD for verbal fluency, 0.36 SD for working memory, and 0.49 SD for cognitive flexibility in comparison to controls. Mean age at assessment was not correlated with the strength of the effect sizes. Mathematics and reading performance, parent ratings of internalizing problems, teacher ratings of externalizing behavior, and attention problems, showed strong and positive correlations with mean birth weight and mean gestational age (all r values > 0.51). CONCLUSIONS: Very preterm and/or VLBW children have moderate-to-severe deficits in academic achievement, attention problems, and internalizing behavioral problems and poor EF, which are adverse outcomes that were strongly correlated to their immaturity at birth. During transition to young adulthood these children continue to lag behind term-born peers.
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Cites
Stroup, D. F. (2000) · JAMA · doi:10.1001/jama.283.15.2008 · Cited by 20,623 · see citing works
The combination of estimates from different experiments
Cochran, W. G. (1954) · Biometrics · doi:10.2307/3001666 · Cited by 5,380 · see citing works
Executive functions and developmental psychopathology.
Pennington, B. F., & Ozonoff, S. (1996) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.1996.tb01380.x · Cited by 3,150 · see citing works
Cognitive and Behavioral Outcomes of School-Aged Children Who Were Born Preterm: A Meta-analysis
Bhutta, A. T., Cleves, M. A., Casey, P. H., Cradock, M. M., & Anand, K. J. S. (2002) · JAMA · doi:10.1001/jama.288.6.728 · Cited by 2,392 · see citing works
Bull, R., & Scerif, G. (2001) · Developmental Neuropsychology · doi:10.1207/s15326942dn1903_3 · Cited by 1,501 · see citing works
Writing meta-analytic reviews.
Rosenthal, R. (1995) · Psychological Bulletin · doi:10.1037/0033-2909.118.2.183 · Cited by 1,108 · see citing works
Barkley, R. A. (1997) · Psychological Bulletin · doi:10.1037//0033-2909.121.1.65 · Cited by 580 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Allotey, J., Zamora, J., Cheong‐See, F., Kalidindi, M., Arroyo‐Manzano, D., Asztalos, E., van der Post, J., Mol, B., Moore, D., Birtles, D., et al. (2018) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.14832 · Cited by 551 · see citing works
Pärtty, A., Kalliomäki, M., Wacklin, P., Salminen, S., & Isolauri, E. (2015) · Pediatric Research · doi:10.1038/pr.2015.51 · Cited by 397 · see citing works
Preterm birth and attention-deficit/hyperactivity disorder in schoolchildren
Lindström, K., Lindblad, F., & Hjern, A. (2011) · Pediatrics · doi:10.1542/peds.2010-1279 · Cited by 334 · see citing works
Attention-deficit/hyperactivity disorder and very preterm/very low birth weight: a meta-analysis
Franz, A. P., Bolat, G. U., Bolat, H., Matijasevich, A., Santos, I. S., Silveira, R. C., Procianoy, R. S., Rohde, L. A., & Moreira-Maia, C. R. (2018) · Pediatrics · doi:10.1542/peds.2017-1645 · Cited by 317 · see citing works
Neurodevelopmental Outcome After Extreme Prematurity: A Review of the Literature
Jarjour, I. T. (2015) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2014.10.027 · Cited by 299 · see citing works
Mental health of extremely low birth weight survivors: A systematic review and meta-analysis.
Mathewson, K. J., Chow, C. H. T., Dobson, K. G., Pope, E. I., Schmidt, L. A., & Van Lieshout, R. J. (2017) · Psychological Bulletin · doi:10.1037/bul0000091 · Cited by 271 · see citing works
Socio-Emotional Development Following Very Preterm Birth: Pathways to Psychopathology
Montagna, A., & Nosarti, C. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.00080 · Cited by 239 · see citing works
Preterm birth and poor fetal growth as risk factors of attention-deficit/ hyperactivity disorder
Sucksdorff, M., Lehtonen, L., Chudal, R., Suominen, A., Joelsson, P., Gissler, M., & Sourander, A. (2015) · Pediatrics · doi:10.1542/peds.2015-1043 · Cited by 219 · see citing works
Pathophysiology of glia in perinatal white matter injury
Back, S. A., & Rosenberg, P. A. (2014) · Glia · doi:10.1002/glia.22658 · Cited by 202 · see citing works
Self-Reported Mental Health Problems Among Adults Born Preterm: A Meta-analysis
Pyhälä, R., Wolford, E., Kautiainen, H., Andersson, S., Bartmann, P., Baumann, N., Brubakk, A.-M., Evensen, K. A. I., Hovi, P., Kajantie, E., et al. (2017) · Pediatrics · doi:10.1542/peds.2016-2690 · Cited by 157 · see citing works
Chew, L.-J., Fusar-Poli, P., & Schmitz, T. (2013) · Developmental Neuroscience · doi:10.1159/000346157 · Cited by 154 · see citing works
Lakshmanan, A., Agni, M., Lieu, T., Fleegler, E., Kipke, M., Friedlich, P. S., McCormick, M. C., & Belfort, M. B. (2017) · Health and Quality of Life Outcomes · doi:10.1186/s12955-017-0602-3 · Cited by 132 · see citing works
Parental Psychological Well-Being and Behavioral Outcome of Very Low Birth Weight Infants at 3 Years
Huhtala, M., Korja, R., Lehtonen, L., Haataja, L., Lapinleimu, H., Rautava, P., & on behalf of the PIPARI Study Group (2012) · Pediatrics · doi:10.1542/peds.2011-2411 · Cited by 133 · see citing works
Huhtala, M., Korja, R., Lehtonen, L., Haataja, L., Lapinleimu, H., & Rautava, P. (2014) · Early Human Development · doi:10.1016/j.earlhumdev.2013.12.009 · Cited by 127 · see citing works
Neel, M. L. M., Stark, A. R., & Maitre, N. L. (2018) · Child: Care, Health and Development · doi:10.1111/cch.12561 · Cited by 114 · see citing works
Parent–child interaction, maternal depressive symptoms and preterm infant cognitive function
McManus, B. M., & Poehlmann, J. (2012) · Infant Behavior and Development · doi:10.1016/j.infbeh.2012.04.005 · Cited by 114 · see citing works
Executive function in children born preterm: Risk factors and implications for outcome
Taylor, H. G., & Clark, C. A. C. (2016) · Seminars in Perinatology · doi:10.1053/j.semperi.2016.09.004 · Cited by 101 · see citing works
A developmental cascade from prenatal stress to child internalizing and Externalizing problems
Hentges, R. F., Graham, S. A., Plamondon, A., Tough, S., & Madigan, S. (2019) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsz044 · Cited by 94 · see citing works
Wolke, D., Baumann, N., Strauss, V., Johnson, S., & Marlow, N. (2015) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2015.02.055 · Cited by 86 · see citing works
Neri, E., Agostini, F., Salvatori, P., Biasini, A., & Monti, F. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01234 · Cited by 86 · see citing works
Sensory processing in preterm preschoolers and its association with executive function
Adams, J. N., Feldman, H. M., Huffman, L. C., & Loe, I. M. (2015) · Early Human Development · doi:10.1016/j.earlhumdev.2015.01.013 · Cited by 85 · see citing works
A meta-analysis of the association between birth weight and attention deficit hyperactivity disorder
Momany, A. M., Kamradt, J. M., & Nikolas, M. A. (2018) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-017-0371-9 · Cited by 82 · see citing works
Everson, T. M., Marsit, C. J., Michael O’Shea, T., Burt, A., Hermetz, K., Carter, B. S., Helderman, J., Hofheimer, J. A., McGowan, E. C., Neal, C. R., et al. (2019) · Scientific Reports · doi:10.1038/s41598-019-42654-4 · Cited by 82 · see citing works
Prenatal glucocorticoid treatment and later mental health in children and adolescents
Khalife, N., Glover, V., Taanila, A., Ebeling, H., Järvelin, M.-R., & Rodriguez, A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0081394 · Cited by 77 · see citing works
Delcour, M., Russier, M., Amin, M., Baud, O., Paban, V., Barbe, M. F., & Coq, J.-O. (2012) · Behavioural Brain Research · doi:10.1016/j.bbr.2012.03.029 · Cited by 72 · see citing works
Castel, S., Creveuil, C., Beunard, A., Blaizot, X., Proia, N., & Guillois, B. (2016) · Early Human Development · doi:10.1016/j.earlhumdev.2016.05.007 · Cited by 60 · see citing works
Complementary assessments of executive function in preterm and full-term preschoolers
Loe, I. M., Chatav, M., & Alduncin, N. (2015) · Child Neuropsychology · doi:10.1080/09297049.2014.906568 · Cited by 58 · see citing works
Eeles, A. L., Anderson, P. J., Brown, N. C., Lee, K. J., Boyd, R. N., Spittle, A. J., & Doyle, L. W. (2013) · Early Human Development · doi:10.1016/j.earlhumdev.2013.05.005 · Cited by 51 · see citing works
Turpin, H., Urben, S., Ansermet, F., Borghini, A., Murray, M. M., & Müller-Nix, C. (2019) · Scientific Reports · doi:10.1038/s41598-018-36465-2 · Cited by 45 · see citing works
Extremely preterm birth and adolescent mental health in a geographical cohort born in the 1990s
Burnett, A., Davey, C. G., Wood, S. J., Wilson-Ching, M., Molloy, C., Cheong, J. L. Y., Doyle, L. W., & Anderson, P. J. (2014) · Psychological Medicine · doi:10.1017/s0033291713002158 · Cited by 44 · see citing works
Birth weight variability and language development: risk, resilience, and responsive parenting.
Madigan, S., Wade, M., Plamondon, A., Browne, D., & Jenkins, J. M. (2015) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsv056 · Cited by 43 · see citing works
Flierman, M., Koldewijn, K., Meijssen, D., van Wassenaer-Leemhuis, A., Aarnoudse-Moens, C., van Schie, P., & Jeukens-Visser, M. (2016) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2016.05.071 · Cited by 31 · see citing works
Self-citationKhoury, J. E., & Milligan, K. (2019) · Journal of Attention Disorders · doi:10.1177/1087054715622016 · Cited by 30 · see citing works
Verstraeten, B. S. E., McCreary, J. K., Weyers, S., Metz, G. A. S., & Olson, D. M. (2019) · Biology of Reproduction · doi:10.1093/biolre/ioy166 · Cited by 28 · see citing works
Landsem, I., Handegård, B., Ulvund, S., Kaaresen, P., & Rønning, J. A. (2015) · Health and Quality of Life Outcomes · doi:10.1186/s12955-015-0221-9 · Cited by 26 · see citing works
Shinya, Y., Kawai, M., Niwa, F., Imafuku, M., & Myowa, M. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.02195 · Cited by 23 · see citing works
Dilworth-Bart, J. E., Poehlmann-Tynan, J. A., Taub, A., Liesen, C. A., & Bolt, D. (2018) · Early Childhood Research Quarterly · doi:10.1016/j.ecresq.2017.09.007 · Cited by 23 · see citing works
Pattern of mother-child feeding interactions in preterm and term dyads at 18 and 24 months
Salvatori, P., Andrei, F., Neri, E., Chirico, I., & Trombini, E. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01245 · Cited by 16 · see citing works
Parental emotional distress after discharge from the neonatal intensive care unit: A pilot study
Ouwendijk-Andréa, M., Bröring-Starre, T., Molderink, A. C., Laarman, C. A. R. C., Oostrom, K. J., & van Dijk-Lokkart, E. M. (2020) · Early Human Development · doi:10.1016/j.earlhumdev.2019.104892 · Cited by 13 · see citing works
Developmental outcomes, attachment and parenting: study of a sample of Spanish premature children
Sierra-García, P., López-Maestro, M., Torres-Valdivieso, M. J., Díaz-González, C., Carrasco, M., Ares-Segura, S., Duque de Blas, G., & Pallás-Alonso, C. (2018) · The Spanish Journal of Psychology · doi:10.1017/sjp.2018.22 · Cited by 11 · see citing works
Ni, M., Li, L., Li, W., Zhang, Q., Zhao, J., Shen, Q., Yao, D., Wang, T., Li, B., Ding, X., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1074783 · Cited by 9 · see citing works
- Authors
- Aarnoudse-Moens, C. S. H., Weisglas-Kuperus, N., van Goudoever, J. B., & Oosterlaan, J.
- Affiliations
- Erasmus MC - Sophia Children’s Hospital (NL)
- Division of Neonatology, Department of Pediatrics, Erasmus University Medical Centre Sophia Children's Hospital, Rotterdam, Netherlands
- Vrije Universiteit Amsterdam (NL)
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2009-08-01
- Volume
- 124
- Issue
- 2
- Pages
- 717-728
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2124141570
- Semantic Scholar
- 5184834aec786cb38f1f4f61176dfa36594d0ee6
- Cited by
- 1,587
- References
- 7
- Citations by year
- 2026: 50 · 2025: 63 · 2024: 56 · 2023: 85 · 2022: 80 · 2021: 138 · 2020: 123 · 2019: 111 · 2018: 113 · 2017: 129 · 2016: 103 · 2015: 112 · 2014: 108 · 2013: 102 · 2012: 97
- FWCI
- 9.48
- Type
- journal article
- Language
- en
- Open access
- green
- research.vu.nl
- Licence
- other-oa
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Keywords
- very preterm children, very low birth weight, neurobehavioral outcomes, academic performance, behavioral problems, executive function, attention deficits, internalizing problems, externalizing problems, birth weight, gestational age, mathematics achievement, reading achievement, working memory, cognitive flexibility, verbal fluency, cognitive impairment, effect size heterogeneity, parent and teacher ratings
- MeSH terms
- Achievement, Adolescent, Attention Deficit Disorder with Hyperactivity, Brain Damage, Chronic, Child, Child Behavior Disorders, Developmental Disabilities, Child, Preschool, Cognition Disorders, Cross-Sectional Studies, Gestational Age, Humans, Infant, Infant, Newborn, Infant, Premature, Diseases, Internal-External Control, Learning Disabilities, Longitudinal Studies, Neurologic Examination, Neuropsychological Tests, Psychometrics, Reference Values, Risk Factors, Statistics as Topic, Infant, Very Low Birth Weight, Infant, Extremely Low Birth Weight
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