title: Very preterm birth and foetal growth restriction are associated with specific cognitive deficits in children attending mainstream school.
abstract: OBJECTIVE
  This study investigated the association of prenatal and neonatal factors with cognitive outcomes in schoolchildren born very preterm without impairments at the age of nine.
  
  
  METHODS
  We recruited a prospective regional cohort of 154 very low gestational age (VLGA) children of <32 weeks and 90 term-born comparison children born between November 1998 and November 2002 at Oulu University Hospital, Finland. Cognitive outcome was assessed using an inclusive neuropsychological test repertoire at the age of nine.
  
  
  RESULTS
  The final study group comprised 77 VLGA children without cerebral palsy or any cognitive impairment and 27 term-born children. VLGA was associated with a 1.5-point [95% confidence interval (CI) 0.6-2.3] reduction in visuospatial-sensorimotor processing and a 1.2-point (95% CI 0.5-1.9) reduction in attention-executive functions scores. Foetal growth restriction (FGR) was the only clinical risk factor that was associated with cognitive outcome. Children with FGR had a significant decrease in language (1.7 points, 95% CI 0.50-3.0) and memory-learning (1.6 points, 95% CI 0.4-2.8) scores.
  
  
  CONCLUSIONS
  Children born very preterm without impairments had poorer performance in specific neurocognitive skills than term-born children. FGR was an independent risk factor for compromised neurocognitive outcome in VLGA children and predicted difficulties in language, memory and learning.
authors.affiliation: Department of Paediatrics, Institute of Clinical Medicine, University of Oulu, Oulu, Finland; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Kallankari
authors.forename: Tuula
authors.initials: T
authors.lastname: Kaukola
authors.forename: Päivi
authors.initials: P
authors.lastname: Olsén
authors.forename: Marja
authors.initials: M
authors.lastname: Ojaniemi
authors.forename: Mikko
authors.initials: M
authors.lastname: Hallman
mesh_terms: D002648:Child; D002652:Child Behavior; D003072:Cognition Disorders / Q000209:etiology*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008297:Male; D047928:Premature Birth; D011446:Prospective Studies
keywords: Developmental outcome; Intrauterine growth restriction; Neurocognitive impairment; Small for gestational age; Very premature infant