Canterbury Child Development Research Group, University of Canterbury, Christchurch, New Zealand.
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
Paediatr Perinat Epidemiol. 2022 Sep;36(5):643-653. doi: 10.1111/ppe.12891. Epub 2022 May 23.
Executive function difficulties are common among children born very preterm and/or very low birthweight (<1500 g; VLBW), but little is known about whether they persist into adulthood.
Examine the nature and pattern of self-reported executive functioning at 23 and 28 years of age using data from a national cohort study of adults born VLBW and a comparison group of same-age full-term (FT) born adults. Also examined were associations between executive function difficulties and socio-economic outcomes.
All infants born VLBW in New Zealand during 1986 were prospectively included in an audit of retinopathy of prematurity (n = 413), with 250 (77% of survivors) followed to median age 28 years. A comparison group of FT adults was also recruited at age 23 and followed to 28 years (n = 100). Across both adult assessments, executive functioning was assessed using the Behaviour Rating Inventory of Executive Function-Adult Version (BRIEF-A) and analysed with semi-parametric models to examine the effects of age and group on executive function.
At 23 and 28 years, VLBW adults had increased risk of executive function impairment compared with FT adults in behaviour regulation (relative risk [CI] 2.37, 95% confidence interval (CI)1.27, 4.45), meta-cognition (RR 6.03, 95% CI 2.18, 16.78) and global functioning (RR 3.20, 95% CI 1.40, 7.28). Impaired global executive functioning was associated with lower socio-economic status (regression estimate [b] = -0.43, 95% CI -0.59, -0.27) and a reduced likelihood of home ownership by age 28 years (RR 0.98, 95% CI 0.96, 1.00), even after controlling for sex, ethnicity and parental socio-economic backgrounds for both groups.
CONCLUSION(S): VLBW-born adults continue to experience more executive function difficulties in their everyday life relative to term controls at age 28 years. These difficulties were negatively associated with their socio-economic opportunities as young adults.
执行功能障碍在极早产儿和/或极低出生体重儿（<1500 克；VLBW）中很常见，但人们对其是否会持续到成年期知之甚少。
使用全国性 VLBW 出生队列研究和同龄足月（FT）出生成人对照组的数据，检查 23 岁和 28 岁时自我报告的执行功能的性质和模式。还研究了执行功能障碍与社会经济结果之间的关系。
1986 年新西兰所有 VLBW 出生的婴儿均前瞻性纳入早产儿视网膜病变（ROP）审核（n=413），其中 250 名（幸存者的 77%）随访至中位年龄 28 岁。同时招募了 FT 成人对照组，在 23 岁时进行评估，并随访至 28 岁（n=100）。在两个成人评估中，均使用行为评定量表的执行功能分量表成人版（BRIEF-A）评估执行功能，并使用半参数模型进行分析，以检验年龄和组别对执行功能的影响。
在 23 岁和 28 岁时，VLBW 组成年人在行为调节（相对风险 [RR] 2.37，95%置信区间 [CI] 1.27，4.45）、元认知（RR 6.03，95% CI 2.18，16.78）和整体功能（RR 3.20，95% CI 1.40，7.28）方面，执行功能障碍的风险高于 FT 组成年人。整体执行功能障碍与较低的社会经济地位相关（回归估计值 [b] -0.43，95% CI -0.59，-0.27），并且到 28 岁时拥有住房的可能性降低（RR 0.98，95% CI 0.96，1.00），即使在控制了两组的性别、种族和父母社会经济背景后也是如此。
VLBW 出生的成年人在 28 岁时的日常生活中仍然会经历更多的执行功能障碍，与足月对照组相比。这些困难与他们作为年轻成年人的社会经济机会呈负相关。
