Leona Pascoe

Effects of correcting for prematurity on cognitive test scores in childhood.

The American Academy of Pediatrics recommends that test scores should be corrected for prematurity up to 3 years of age, but this practice varies greatly in both clinical and research settings. The aim of this study was to contrast the effects of using chronological age and those of using corrected age on measures of cognitive outcome across childhood.

Preventing academic difficulties in preterm children: a randomised controlled trial of an adaptive working memory training intervention - IMPRINT study

BackgroundVery preterm children exhibit difficulties in working memory, a key cognitive ability vital to learning information and the development of academic skills. Previous research suggests that an adaptive working memory training intervention (Cogmed) may improve working memory and other cognitive and behavioural domains, although further randomised controlled trials employing long-term outcomes are needed, and with populations at risk for working memory deficits, such as children born preterm.In a cohort of extremely preterm (<28 weeks’ gestation)/extremely low birthweight (<1000 g) 7-year-olds, we will assess the effectiveness of Cogmed in improving academic functioning 2 years’ post-intervention. Secondary objectives are to assess the effectiveness of Cogmed in improving working memory and attention 2 weeks’, 12 months’ and 24 months’ post-intervention, and to investigate training related neuroplasticity in working memory neural networks 2 weeks’ post-intervention.Methods/DesignThis double-blind, placebo-controlled, randomised controlled trial aims to recruit 126 extremely preterm/extremely low birthweight 7-year-old children. Children attending mainstream school without major intellectual, sensory or physical impairments will be eligible. Participating children will undergo an extensive baseline cognitive assessment before being randomised to either an adaptive or placebo (non-adaptive) version of Cogmed. Cogmed is a computerised working memory training program consisting of 25 sessions completed over a 5 to 7 week period. Each training session takes approximately 35 minutes and will be completed in the child’s home. Structural, diffusion and functional Magnetic Resonance Imaging, which is optional for participants, will be completed prior to and 2 weeks following the training period. Follow-up assessments focusing on academic skills (primary outcome), working memory and attention (secondary outcomes) will be conducted at 2 weeks’, 12 months’ and 24 months’ post-intervention.DiscussionTo our knowledge, this study will be the first randomised controlled trial to (a) assess the effectiveness of Cogmed in school-aged extremely preterm/extremely low birthweight children, while incorporating advanced imaging techniques to investigate neural changes associated with adaptive working memory training, and (b) employ long-term follow-up to assess the potential benefit of improved working memory on academic functioning. If effective, Cogmed would serve as a valuable, available intervention for improving developmental outcomes for this population.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12612000124831.

Accelerated corpus callosum development in prematurity predicts improved outcome

To determine: (1) whether corpus callosum (CC) size and microstructure at 7 years of age or their change from infancy to 7 years differed between very preterm (VP) and full‐term (FT) children; (2) perinatal predictors of CC size and microstructure at 7 years; and (3) associations between CC measures at 7 years or trajectories from infancy to 7 years and neurodevelopmental outcomes.

Developmental Trajectory of Language From 2 to 13 Years in Children Born Very Preterm

In this prospective longitudinal study of children born VP or term, the authors examined language functioning at 13 years of age and language development from the age of 2 years. OBJECTIVES: The objective of this study was to describe language functioning at 13 years of age and examine its developmental trajectory from 2 to 13 years of age in children born very preterm (VP) compared with term controls. METHODS: Two hundred and twenty-four children born VP (<30 weeks’ gestation) and 77 term controls had language skills assessed by using performance-based and/or parent-report measures at 2, 5, 7, and 13 years of age. Regression models were used to compare verbal memory, grammar, semantics, and pragmatic skills between the VP and term groups at 13 years of age. Linear mixed effects regression models were used to assess language trajectories from 2 to 13 years of age. RESULTS: Compared with term controls, children born VP had poorer functioning across all components of language (mean group differences ranged from −0.5 SD to −1 SD; all P < .05) at 13 years of age. At each follow-up age, the VP group displayed poorer language functioning than the term controls, with the groups exhibiting similar developmental trajectories (slope difference = −0.01 SD per year; P = .55). CONCLUSIONS: Children born VP continue to display language difficulties compared with term controls at 13 years of age, with no evidence of developmental “catch-up.” Given the functional implications associated with language deficits, early language-based interventions should be considered for children born VP.

A simple screen performed at school entry can predict academic under-achievement at age seven in children born very preterm

We aimed to compare the academic outcomes of a cohort of children born very preterm (VPT, <32 weeks of gestation) and children born at term at age 7 years and assess the ability of a pre‐academic skill screen at age five to predict later academic impairment in children born VPT at age seven.

A simple screen performed at school entry can predict academic under-achievement in children born very preterm at age seven

We aimed to compare the academic outcomes of a cohort of children born very preterm (VPT, <32 weeks of gestation) and children born at term at age 7 years and assess the ability of a pre‐academic skill screen at age five to predict later academic impairment in children born VPT at age seven.

Long-Term Academic Functioning Following Cogmed Working Memory Training for Children Born Extremely Preterm: A Randomized Controlled Trial

Objective To assess the effectiveness of Cogmed Working Memory Training compared with a placebo program in improving academic functioning 24 months post‐training in extremely preterm/extremely low birth weight 7‐year‐olds. Study design A multicenter double‐blind, placebo‐controlled randomized controlled trial was conducted across all tertiary neonatal hospitals in the state of Victoria, Australia. Participants were 91 extremely preterm/extremely low birth weight 7‐year‐old children born in Victoria in 2005. Children were randomly assigned to either the Cogmed or placebo arm and completed the Cogmed or placebo program (20‐25 sessions of 35‐40 minutes duration) at home over 5‐7 weeks. Academic achievement (word reading, spelling, sentence comprehension, and mathematics) was assessed 24 months post‐training, as well as at 2 weeks and 12 months post‐training, via standardized testing inclusive of working memory, attention, and executive behavior assessments. Data were analyzed using an intention‐to‐treat approach with mixed‐effects modeling. Results There was little evidence of any benefits of Cogmed on academic functioning 24 months post‐training, as well as on working memory, attention, or executive behavior at any age up to 24 months post‐training compared with the placebo program. Conclusions We currently do not recommend administration of Cogmed for early school‐aged children born extremely preterm/extremely low birth weight to improve academic functioning. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12612000124831.

Goal Setting Deficits at 13 Years in Very Preterm Born Children

OBJECTIVES Preterm children demonstrate deficits in executive functions including inhibition, working memory, and cognitive flexibility; however, their goal setting abilities (planning, organization, strategic reasoning) remain unclear. This study compared goal setting abilities between very preterm (VP: <30 weeks/<1250 grams) and term born controls during late childhood. Additionally, early risk factors (neonatal brain abnormalities, medical complications, and sex) were examined in relationship to goal setting outcomes within the VP group. METHODS Participants included 177 VP and 61 full-term born control children aged 13 years. Goal setting was assessed using several measures of planning, organization, and strategic reasoning. Parents also completed the Behavior Rating Inventory of Executive Function. Regression models were performed to compare groups, with secondary analyses adjusting for potential confounders (sex and social risk), and excluding children with major neurosensory impairment and/or IQ<70. Within the VP group, regression models were performed to examine the relationship between brain abnormalities, medical complications, and sex, on goal setting scores. RESULTS The VP group demonstrated a clear pattern of impairment and inefficiency across goal setting measures, consistent with parental report, compared with their full-term born peers. Within the VP group, moderate/severe brain abnormalities on neonatal MRI predicted adverse goal setting outcomes at 13. CONCLUSIONS Goal setting difficulties are a significant area of concern in VP children during late childhood. These difficulties are associated with neonatal brain abnormalities, and are likely to have functional consequences academically, socially and vocationally. (JINS, 2018, 24, 372-381).