Department of Psychology, University of Turku, Turku, Finland.
Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland.
J Dev Behav Pediatr. 2019 Sep;40(7):547-554. doi: 10.1097/DBP.0000000000000689.
Executive function (EF) problems of children born at very low birth weight (VLBW; ≤1500 g) or very low gestational age (VLGA; <32 gestational weeks) may present differently at school compared to the home environment. Ecological assessment of EF including parent- and teacher-rated profiles and associated risk factors of 11-year-old children born at VLBW or VLGA was evaluated.
A total of 125 VLBW or VLGA children and 132 controls were assessed using the Behavior Rating Inventory of EF, which includes 8 subscales that form the Behavioral Regulation and Metacognition Indexes. For VLBW or VLGA children, full-scale intelligence quotient (IQ) was assessed using the Wechsler Intelligence scale for Children, Fourth Edition. Neonatal data were collected systematically.
VLBW or VLGA children with full-scale IQ ≥ 70 had clinically significant problems in the Working Memory subscale at school. Although they had clinically significant problems at home in the Behavioral Regulation Index, the difference disappeared when adjusted for paternal education. Lower gestational age, lower birth weight z-score, surgical necrotizing enterocolitis, low paternal and maternal education, and lower full-scale IQ were identified to be risk factors for higher scores in ecological assessment of EF.
VLBW or VLGA children in this cohort exhibit fewer EF problems in ecological assessment of EF compared to previous literature. EF problems of this study population vary by home and school setting and are emphasized in working memory at school. Screening for EF problems in school environment is recommended to target the support.
极低出生体重（VLBW；≤1500 克）或极早产（VLGA；<32 孕周）儿的执行功能（EF）问题在学校环境中可能与家庭环境不同。本研究评估了 11 岁 VLBW 或 VLGA 儿童的 EF 生态评估，包括父母和教师评定的概况及其相关危险因素。
使用行为评定量表 EF 评估了 125 名 VLBW 或 VLGA 儿童和 132 名对照组儿童，该量表包括 8 个分量表，形成行为调节和元认知指数。对于 VLBW 或 VLGA 儿童，使用韦氏儿童智力量表第四版评估了全面智商（IQ）。系统地收集了新生儿数据。
具有全量表智商≥70 的 VLBW 或 VLGA 儿童在学校的工作记忆分量表上存在临床显著的问题。尽管他们在家中的行为调节指数上存在临床显著问题，但在校正父亲的教育程度后，这种差异消失了。较低的胎龄、出生体重 z 评分、手术坏死性小肠结肠炎、父母较低的教育程度和较低的全量表智商被确定为 EF 生态评估中得分较高的危险因素。
本队列中的 VLBW 或 VLGA 儿童在 EF 的生态评估中表现出较少的 EF 问题，与之前的文献相比。该研究人群的 EF 问题因家庭和学校环境而异，在学校环境中的工作记忆方面更为突出。建议在学校环境中筛查 EF 问题，以提供针对性支持。
