School outcome, cognitive functioning, and behaviour problems in moderate and late preterm children and adults: A review

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Summary

A large number of children (6 to 11% of all births) are born at a gestational age between 32 and 36 weeks. Little is known of long term outcomes for these moderate and late preterm children. In this review, results of 28 studies on school outcome, cognitive functioning, behaviour problems, and psychiatric disorders are presented. Overall, more school problems, less advanced cognitive functioning, more behaviour problems, and higher prevalence of psychiatric disorders were found in moderate and late preterm born infants, children, and adults compared with full term peers. Suggestions for future research are discussed.

Introduction

Many infants are born too soon and therefore are at risk for developmental problems. In 2007, 10.7% of all children in the USA (6.1% in The Netherlands1) were born at a gestational age between 32 and 36 weeks, i.e. moderate (32–33 weeks) and late (34–36 weeks) preterm.2 This entails 84% of all preterm births. During the last two decades, the number of preterm births increased by almost 25%, with a 4% increase in very preterm births (i.e. below 32 weeks’ gestation) versus a 30% increase in moderate and late preterm births.2 Hence, the number of children in this group especially has increased over the last 20 years. Although mortality rates are much lower (7.5 times) in these children than in very preterm children, these rates are almost 10 times higher than in full term children.3 With respect to neonatal complications, moderate and late preterm infants experience fewer illnesses than very preterm infants, but they are at elevated risk for breathing and feeding difficulties, hypoglycaemia, and hyperbilirubinaemia compared with full term infants.4 Another risk factor results from the fact that the brain of moderate and late preterm children is still immature; at 34 weeks of gestation, the brain weighs only 65% of the weight at 40 weeks of gestation.5 Despite the high prevalence and increased medical risk of moderate and late preterm birth, little is known of long-term developmental outcomes of these children. In this review the available information on school outcome, cognitive functioning, behaviour problems, and psychiatric disorders of infants, children, and adults born moderate or late preterm is presented.

Section snippets

Search strategy and study selection

The Scopus database was searched until 23 June 2011, using the terms: ‘late preterm’, ‘moderately preterm’, and ‘moderate preterm’. In addition, reference lists of selected articles were examined to find additional studies.

Studies were included if: (i) these were published after 1 January 2000; (ii) gestational age of participants was between 32 and 36+6 weeks; and (iii) these investigated school outcome, cognitive functioning, behaviour problems or psychiatric disorders.

Included studies

The three search terms resulted in 485 hits. Based on title and abstract, 449 studies were excluded. Thirty-six articles were read full text and 16 of these were excluded because outcome measures were beyond the scope of this review (n = 11) or because the studies did not concern empirical data collection and analyses (n = 5). In four of the included studies, gestational age of the participants differed slightly from our inclusion criterion (i.e. selected 31 and/or 37 weeks of gestation).6, 7, 8

Discussion

The aim of this review has been to gain more insight into long term developmental outcomes of moderate and late preterm children, specifically in school outcome, cognitive functioning, behaviour problems, and psychiatric disorders. Based upon the 28 studies included in this review, we conclude that moderate/late preterm children show more school problems, have lower IQ scores, and more behaviour problems than their full term peers. For psychiatric disorders it is concluded that especially ADHD

Conflict of interest statement

None declared.

Funding sources

None.

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