Executive function deficits in children born preterm or at low birthweight: a meta‐analysis

van Houdt, Carolien A; Oosterlaan, Jaap; van Wassenaer‐Leemhuis, Aleid G; van Kaam, Anton H; Aarnoudse‐Moens, Cornelieke S H · 2019 · Crossref

DOI: 10.1111/dmcn.14213

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Summary

This meta-analysis investigates the magnitude of executive function deficits in children born preterm or with low birthweight and determines whether these deficits are influenced by gestational age, sex, age at assessment, or year of birth. The study was motivated by the critical role executive functions play in academic and behavioral outcomes, noting that previous meta-analyses from 2009 required updating to include recent literature and a broader range of preterm births. The authors aimed to quantify impairments in working memory, inhibition, and cognitive flexibility to better understand the cognitive profile of this population. The researchers conducted a systematic search of PubMed, PsychINFO, Web of Science, and ERIC for studies published after 2009 involving children born in 1990 or later (post-introduction of antenatal steroids and surfactant). Inclusion criteria required participants to be at least four years old at assessment and studies to report on tasks measuring working memory, inhibition, or cognitive flexibility that were used in at least five separate papers to ensure robustness. After screening 3,030 articles, 35 studies comprising 3,360 children born preterm/low birthweight and 2,812 term-born controls were included. Data were extracted for specific tasks, such as the Digit Span Task for working memory and Go/No-Go for inhibition. Statistical analyses employed random-effects meta-analyses to calculate standardized mean differences (SMDs) and meta-regressions to assess moderator effects. The results indicate that children born preterm or with low birthweight performed significantly worse than term-born peers on all three executive function domains. Specifically, they scored 0.52 SMD lower on working memory, 0.39 SMD lower on inhibition, and 0.51 SMD lower on cognitive flexibility. There were no significant differences in the magnitude of deficits between the three domains. Meta-regression analyses revealed that heterogeneity in effect sizes for working memory and inhibition could not be explained by gestational age, sex, age at assessment, or year of birth. Although an initial significant relationship between gestational age and working memory was observed, it was driven by two outlier studies at the extreme ends of the gestational age distribution; removing these studies rendered the relationship non-significant. No evidence of publication bias was found. The study concludes that children born preterm or with low birthweight exhibit stable, medium-to-small executive function deficits that do not improve with increasing age or recent advances in neonatal care. These deficits are comparable across working memory, inhibition, and cognitive flexibility and are not significantly associated with male sex or lower gestational age within the studied ranges. The findings suggest that executive function impairments are a persistent risk factor for the academic and behavioral difficulties observed in this population, likely linked to underlying white matter and striatal vulnerabilities. The authors emphasize the need for further research on extremely preterm and moderate-to-late preterm groups to clarify potential gestational age effects.

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• executive function