Behboodi Soodabeh, Chaimani Anna, Benhammou Valerie, Twilhaar E Sabrina, Johnson Samantha, Zeitlin Jennifer, Sentenac Mariane
Obstetrical, Perinatal, Pediatric Life Course Epidemiology, Centre for Research in Epidemiology and Statistics, Institut national de recherche pour l'agriculture, l'alimentation et l'environnement, Institut national de la sante et de la recherche médicale, Université Paris Cité, Paris, France.
Centre for Research in Epidemiology and Statistics, Institut national de recherche pour l'agriculture, l'alimentation et l'environnement, Institut national de la sante et de la recherche médicale, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France.
JAMA Pediatr. 2025 Jul 28. doi: 10.1001/jamapediatrics.2025.2221.
Progress in perinatal care has improved survival for children born very preterm (VPT), but these children remain at higher risk of cognitive impairment compared with children born at term.
To synthesize cohort studies on childhood cognitive ability following VPT birth to investigate trends over time.
All studies from 5 previous meta-analyses of VPT birth and cognition published before 2019 were included, and PubMed, Web of Science, and PsycInfo were searched for new studies published up to June 2024.
Studies reporting IQ scores of children (aged <18 years) born VPT (<32 weeks' gestational age [GA] or birth weight <1500 g) with a term-born comparison group were included.
Two reviewers independently selected studies, extracted data, and evaluated study quality using a modified version of the Newcastle-Ottawa Scale. Unique cohorts were identified to avoid duplicate measures from studies on the same children.
The standardized mean difference (SMD) of IQ scores between VPT-born and term-born children was calculated, and mixed-effects metaregression was used to investigate linear and nonlinear associations between median birth year and the SMD. The main analysis focused on cohorts with IQ measured between 4 and 7 years of age to allow comparison at similar assessment ages. Secondary analyses were conducted in all cohorts using IQ obtained at the latest assessment age.
A total of 257 studies reported data from 131 cohorts of 25 746 individuals born from 1977 to 2016 (15 548 born VPT and 10 198 at term). In the 61 cohorts assessed at age 4 to 7 years (13 842 children born between 1977 and 2014 [8847 born VPT and 4995 at term]; mean [SD] GA, 28.2 [1.7] weeks for the VPT cohorts), IQ was lower for VPT-born children compared with term-born children (SMD = -0.88; 95% CI, -0.97 to -0.79). The linear model showed no association with birth year (β = -0.002; 95% CI,-0.012 to 0.008). Three types of nonlinear models were fit, with no nonlinear associations observed. Adjustment for GA and study characteristics did not change the results (β = -0.001; 95% CI, -0.013 to 0.011). Secondary analysis of 131 cohorts found a similar difference between VPT and term groups (SMD = -0.84; 95% CI, -0.90 to -0.79), with no time trend (β = 0.001; 95% CI, -0.005 to 0.007).
On average, children born VPT had significantly lower IQ scores than term-born children, and this deficit did not decrease in studies conducted over 4 decades.
围产期护理的进展提高了极早产儿（VPT）的存活率，但与足月儿相比，这些儿童仍有更高的认知障碍风险。
综合关于VPT出生后儿童认知能力的队列研究，以调查随时间的趋势。
纳入了2019年之前发表的5项先前关于VPT出生与认知的荟萃分析中的所有研究，并在PubMed、科学网和PsycInfo中检索了截至2024年6月发表的新研究。
纳入报告了VPT出生（胎龄<32周[GA]或出生体重<1500 g）的儿童（年龄<18岁）与足月儿对照组的智商分数的研究。
两名评审员独立选择研究、提取数据，并使用纽卡斯尔-渥太华量表的修改版评估研究质量。识别出独特的队列，以避免对同一儿童的研究进行重复测量。
计算VPT出生儿童与足月儿之间智商分数的标准化平均差（SMD），并使用混合效应元回归研究中位出生年份与SMD之间的线性和非线性关联。主要分析集中在智商在4至7岁之间测量的队列，以便在相似的评估年龄进行比较。在所有队列中使用最新评估年龄获得的智商进行二次分析。
共有257项研究报告了来自1977年至2016年出生的25746名个体的131个队列的数据（15548名VPT出生，10198名足月儿）。在4至7岁时评估的61个队列（1977年至2014年出生的13842名儿童[8847名VPT出生，4995名足月儿]；VPT队列的平均[标准差]GA为28.2[1.7]周）中，VPT出生的儿童的智商低于足月儿（SMD = -0.88；95%CI，-0.97至-0.79）。线性模型显示与出生年份无关联（β = -0.002；95%CI，-0.012至0.008）。拟合了三种类型的非线性模型，未观察到非线性关联。对GA和研究特征进行调整并未改变结果（β = -0.001；95%CI，-0.013至0.011）。对131个队列的二次分析发现VPT组和足月儿组之间存在类似差异（SMD = -0.84；95%CI，-0.90至-0.79），且无时间趋势（β = 0.001；95%CI，-0.005至0.007）。
平均而言，VPT出生的儿童的智商分数显著低于足月儿，并且在40多年的研究中这种缺陷并未减少。
