Friday, March 6, 2015

Preterm and Late Preterm Infant Neurocognitive Performance Follow-up Studies Continue To Develop

By: Lewis First, MD, MS; Editor-in-Chief 

         Our readers tell us they learn a lot reading the studies we publish on long-term follow-up of infants born early particularly in terms of their neurodevelopment. Well this week we don’t want to disappoint, and therefore bring you three studies of interest in the area of cognitive development of preterm, and late preterm infants. The first study by Burnett et al.  (doi:10.1542/peds.2014-3556) focuses on extremely preterm (less than 28 weeks) and extremely low birth weight (less than 1000 g) infants in terms of their executive function, not just in infancy and toddlerhood but into adolescence. 
         Sadly, poor performance in executive function tasks seen early in life carries on into the teen years, and while some aspects of executive function improve over time, a number of aspects do not, suggesting the need to intervene sooner than later to try to further develop executive function skills over time.
         A second study by Heinonen et al. (doi:10.1542/peds.2014-3556) looks at late preterm infants and follows their neurocognitive performance not just into adolescence, but into late adulthood. The authors traced a cohort of more than 900 men and women born in Finland in 1934-44 who were assessed  as adults with a battery of tests to identify signs of Alzheimer disease and believe it or not, those who were identified as late-preterm had a higher risk of showing neurocognitive impairment.  Interestingly enough however, those who were able to pursue higher education did not show such findings. 
          Finally there is a third study by Schonhaut et al. (doi:10.1542/peds.2014-1957)  that looks at developmental impairment relative to gestational age in moderate, late preterm and early term infants and once again, there is an inverse association between gestational age and developmental delay.
          There are a lot of interesting comments one can make about the findings in all three studies, and at the same time, one has to be amazed that cohorts of infants are now being followed not just into early childhood but through adolescence and into adulthood without major losses to follow-up.  As a result, we are learning more and more about the developmental outcomes associated with being born early.  To help make even more sense of these types of studies and what we can do to perhaps improve developmental outcomes in these patients, Dr. Betty Vohr (doi:10.1542/peds.2015-0227) offers her perspective in a very interesting commentary.  Read all three studies and the commentary and then see what develops in regard to interventional strategies to improve developmental outcomes in these infants born preterm.

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