Lasting effects of preterm birth and neonatal brain hemorrhage at 12 years of age.
OBJECTIVE
Our goals were to compare cognitive, language, behavioral, and educational outcomes of preterm children to term controls and to evaluate the impact of neonatal brain injury, indomethacin, and environmental risk factors on intellectual function at 12 years of age.


METHODS
A total of 375 children born in 1989-1992 with birth weights of 600 to 1250 g enrolled in the Indomethacin Intraventricular Hemorrhage Prevention Trial and 111 controls were evaluated. Neuropsychometric testing, neurologic examination, and interviews on educational needs were completed. Severe brain injury was defined as the presence of grade 3 to 4 indomethacin intraventricular hemorrhage, periventricular leukomalacia, or severe ventriculomegaly on cranial ultrasound.


RESULTS
On the Wechsler Scales of Intelligence for Children, the preterm cohort obtained a full-scale IQ of 87.9 +/- 18.3, verbal IQ of 90.8 +/- 18.9, and performance IQ of 86.8 +/- 17.9. Preterm children obtained scores 6 to 14 points lower than term controls on all psychometric tests after adjustment for sociodemographic factors. On the Clinical Evaluation of Language Fundamentals (test of basic language skills), 22% to 24% of preterm children scored in the abnormal ranges (<70) as opposed to 2% to 4% of controls. Preterm children with and without brain injury required more school services (76% and 44% vs 16%), and support in reading (44% and 28% vs 9%), writing (44% and 20% vs 4%), and mathematics (47% and 30% vs 6%) compared with controls. Preterm children also displayed more behavior problems than their term counterparts. Severe neonatal brain injury was the strongest predictor of poor intelligence. Antenatal steroids, higher maternal education, and 2-parent family were associated with better cognition, whereas minority status incurred a disadvantage. Indomethacin did not affect intellectual function among preterm children.


CONCLUSIONS
Preterm children born in the early 1990s, especially those with severe brain injury, demonstrate serious deficits in their neuropsychological profile, which translates into increased use of school services at 12 years.
Luu
Thuy Mai
TM
Women and Infants Hospital, Department of Pediatrics, 101 Dudley St, Providence, RI 02905, USA.
Ment
Laura R
LR
Schneider
Karen C
KC
Katz
Karol H
KH
Allan
Walter C
WC
Vohr
Betty R
BR
D001925:Brain Damage, Chronic / Q000175:diagnosis* / Q000517:prevention & control; D002552:Cerebral Ventricles; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000517:prevention & control; D007360:Intelligence / Q000187:drug effects; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000517:prevention & control; D007805:Language Development Disorders / Q000175:diagnosis; D007859:Learning Disabilities / Q000175:diagnosis; D007969:Leukomalacia, Periventricular / Q000175:diagnosis; D008297:Male; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012737:Sex Factors; D014888:Wechsler Scales
D007213:Indomethacin