, et al
Do healthy preterm children need neuropsychological follow-up? Preschool outcomes compared to term peers
Dev Med Child Neurol
; doi:

Researchers from Ospedale Pediatrico Bambino Gesu in Rome investigated whether healthy children born prematurely performed differently from term-born children on neuropsychological measures that may predict later learning/academic difficulties. Infants born at less than 33 weeks gestation with a neonatal course without major neurologic or sensory morbidities and without developmental disability at 2 years of age were enrolled in the study. Sex- and age-matched children born at term served as controls. Children from both groups were evaluated at 4 years of age. Cognitive status (developmental quotient or DQ) was assessed using The Griffiths Mental Developmental Scales, with scores of 90 or above considered normal.1 Neuropsychological status was measured utilizing a variety of instruments which focused on expressive/receptive language; verbal and visual short-term memory; visual, motor, and constructive spatial abilities; and visual processing.

A total of 85 children were enrolled; 35 of these were preterm (mean gestational age 29.4 weeks) and 50 were born at term. Ages at assessment for the preterm and term groups were 4.4 years and 4.5 years, respectively. A majority of preterm children had a DQ score in the normal range, but their global mean score was lower than that of the term group (97.4 vs 103.4; P<.001). When outcomes were adjusted for DQ score and maternal education, preterm children scored significantly lower on assessments of verbal fluency, verbal and visual-spatial short-term memory, and spatial abilities.

The authors conclude that children born prematurely who appear developmentally normal at age 2 years demonstrate neuropsychological deficits (language, executive function) when assessed at age 4 years, despite DQs in the normal range. Thus, evaluation of these children is needed to identify their strengths and challenges before they start school to plan interventions that can maximize their academic success.

Dr Nalven has disclosed that her husband is an employee of Eisai Pharmaceuticals. This commentary does not contain a discussion of an unapproved/investigative use of commercial products/devices.

This study highlights the resiliency of children born prematurely and documents the persistence of subtle neuropsychological deficits in those without obvious neurological sequelae that can have a major impact on school/academic function. Other studies have shown similar results.2,3 Longer outcome studies of children born prematurely confirm the impact of such deficits on school performance.4,5 As with preterm infant follow-up programs in the United States, this center in Italy routinely follows children only until 2 years of age. Those who exhibit “normal” development at this age are not monitored further. The results of the study support routine assessment of children born prematurely prior to kindergarten entry so that individualized plans of appropriate remediation and supportive services can be put in place.

Ideally, preterm infant follow-up programs would extend through kindergarten to provide focused...

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