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Preterm birth occurs during a critical period of brain development. For babies born before 26 weeks’ gestational age, neurons have just completed migration to the cortex and are starting to form a network of connections. Cortical surface area is expanded through gyration and maturation continues with myelination of the axons. Unfortunately, extremely preterm babies are not only vulnerable to direct brain injury but their exposure to physiological and metabolic stress resulting from their systemic illness may also permanently disrupt normal brain ontogenesis leading to long-lasting cognitive deficits.
This is highlighted in the EPICure cohort study which reported on 315 infants born in 1995 in the UK and Ireland before 26 weeks’ gestational age. These infants were prospectively assessed for cognitive function at 2.5, 6, 11 and 19 years of age.1 Term-born controls were recruited starting at 6 years allowing for longitudinal comparisons from school entry through to early adulthood. What this study showed was the quite significant 25-point gap in intellectual quotient (IQ) (ie, nearly two SD) for the extremely preterm group relative to term-born controls across years. Within the extremely preterm group, being a male and having sustained a severe neonatal brain injury conferred additional disadvantage. Higher maternal education …
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