Costa Danielle S, Miranda Débora M, Burnett Alice C, Doyle Lex W, Cheong Jeanie L Y, Anderson Peter J
Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior, Ministry of Education of Brazil, Brasília, Brazil.
Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Pediatrics. 2017 Sep;140(3). doi: 10.1542/peds.2017-0257.
Cognitive and behavioral impairments of children born extremely preterm (EP) (<28 weeks' gestation) and extremely low birth weight (ELBW) (<1000 g) may change with age. We assessed the individual stability of behavioral executive function (EF) from 8 to 18 years of age in children born EP or ELBW and their academic outcomes.
Participants comprised 180 children born EP or ELBW from a large geographic cohort. We investigated the frequency of 4 developmental groups (persistent, remitting, late-onset, and typical development) on the basis of dichotomized scores (typical versus elevated) at ages 8 and 18 years in 2 indices (the Behavioral Regulation Index [BRI] and the Metacognition Index [MCI]) of the parental form of the Behavior Rating Inventory of Executive Function. Adolescent academic outcomes were measured by using the word reading, spelling, and math computation subtests of the Wide Range Achievement Test, Fourth Edition.
Most participants had a typical EF (BRI 61%, MCI 53%), followed by persistent (BRI 15%, MCI 16%), late-onset (BRI 12%, MCI 19%), or remitting (BRI 12%, MCI 13%) executive difficulties. Groups with executive impairments at age 18 years (persistent and late onset) had poorer academic outcomes than the typical and remitting groups. Shifting impairment categories between 8 and 18 years old was relevant to later academic outcomes.
Most children showed stable and age-appropriate EF, although persistent and transient difficulties were observed and related to uneven academic outcomes. Studying the origins and consequences of the developmental stability of EF may contribute to the development of interventions to decrease the adverse neurodevelopmental outcomes of preterm birth.
极早产儿（孕周<28周）和极低出生体重儿（出生体重<1000克）的认知和行为障碍可能会随年龄变化。我们评估了极早产儿或极低出生体重儿从8岁到18岁行为执行功能（EF）的个体稳定性及其学业成绩。
参与者包括来自一个大型地理队列的180名极早产儿或极低出生体重儿。我们根据执行功能行为评定量表家长版的2个指标（行为调节指数[BRI]和元认知指数[MCI]）在8岁和18岁时的二分得分（典型与升高），调查了4个发育组（持续、缓解、迟发和典型发育）的频率。青少年学业成绩通过使用《广泛成就测验》第四版的单词阅读、拼写和数学计算子测验来衡量。
大多数参与者具有典型的EF（BRI为61%，MCI为53%），其次是持续性（BRI为15%，MCI为16%）、迟发性（BRI为12%，MCI为19%）或缓解性（BRI为12%，MCI为13%）执行困难。18岁时存在执行功能障碍的组（持续和迟发）的学业成绩比典型组和缓解组差。8岁至18岁之间执行功能障碍类别发生变化与后期学业成绩相关。
大多数儿童表现出稳定且符合年龄的EF，尽管观察到了持续性和短暂性困难，且这些困难与不均衡的学业成绩相关。研究EF发育稳定性的起源和后果可能有助于开发干预措施，以减少早产的不良神经发育后果。
