Elsevier

The Journal of Pediatrics

Volume 161, Issue 5, November 2012, Pages 824-829.e1
The Journal of Pediatrics

Original Article
Attention Problems of Very Preterm Children Compared with Age-Matched Term Controls at School-Age

https://doi.org/10.1016/j.jpeds.2012.05.010Get rights and content

Objectives

To clarify the severity, specificity, and neurocognitive underpinnings of attention problems in very preterm children.

Study design

A sample of 66 preterm (<32 weeks gestation), mean (SD) age 7.5 (0.4) years, and 66 age-matched term controls participated. Symptoms of inattention were assessed using parent and teacher-rated questionnaires, and neurocognitive measures included speed and consistency in speed of information processing, lapses of attention (tau), alerting, orienting, and executive attention, as well as verbal and visuospatial working memory. Group differences were investigated using ANOVA, and Sobel tests were used to clarify the mediating role of neurocognitive impairments on attention problems.

Results

There was a large decrease in visuospatial working memory abilities (P < .001, d = .87), and medium increases in tau (P = .002, d = 0.55) as well as parent and teacher ratings of inattention (range d = 0.40-0.56) in very preterm children compared with term peers. Tau and visuospatial working memory were significant predictors of parent (R2 = .161, P < .001 and R2 = .071, P = .001; respectively) and teacher (R2 = .152, P < .001 and R2 = .064, P = .002; respectively) ratings of inattention, and completely explained the effects of very preterm birth on attention problems.

Conclusions

Increased lapses of attention and poorer visuospatial working memory fully account for the attention problems in very premature children at school-age.

Section snippets

Methods

A sample of 66 very preterm (<32 weeks gestation) children and 66 age-matched term controls participated. All 66 very preterm children had participated in a randomized controlled trial on enteral glutamine supplementation (0.3 g/kg/d) between day 3 and 30 of life.15 For this study, all very preterm children admitted between September 2001 and July 2003 to the level III neonatal intensive care unit of the VU University Medical Center Amsterdam were eligible for inclusion, and baseline

Results

Age, SES, and sex were not different between very preterm children and their term peers (Table I). No differences were present for age (P = .87), SES (P = .25), and sex (P = .23) between both recruiting methods of age-matched peers. Furthermore, no significant effects of sex and being small for gestational age were found on any of the included neurocognitive measures in very preterm children (all Ps > .05, all ds < 0.33). As expected, very preterm children had significantly lower full-scale IQ

Discussion

Our study confirms that very preterm birth is associated with a medium sized increase in attention problems as reported by both parents and teacher (range d = 0.40-0.56). Furthermore, we found multiple deficits in the neurocognitive functions involved in attention, including a greater proportion of extremely slow responses (tau) and poorer visuospatial working memory abilities for very preterm children compared with age-matched term peers. Importantly, our findings clearly indicate that

References (40)

  • C.S. Aarnoudse-Moens et al.

    Development of preschool and academic skills in children born very preterm

    J Pediatr

    (2011)
  • C. Fassbender et al.

    A lack of default network suppression is linked to increased distractibility in ADHD

    Brain Res

    (2009)
  • C.S. Aarnoudse-Moens et al.

    Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children

    Pediatrics

    (2009)
  • A.T. Bhutta et al.

    Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis

    JAMA

    (2002)
  • J.F. de Kieviet et al.

    Motor development in very preterm and very low-birth-weight children from birth to adolescence: a meta-analysis

    JAMA

    (2009)
  • H. Mulder et al.

    Development of executive function and attention in preterm children: a systematic review

    Dev Neuropsychol

    (2009)
  • M.J. Kane et al.

    A controlled-attention view of working-memory capacity

    J Exp Psychol Gen

    (2001)
  • M. Arns et al.

    Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis

    Clin EEG Neurosci

    (2009)
  • F. Verhulst et al.

    Handleiding voor de CBCL/4-18

    (1996)
  • J. Oosterlaan et al.

    Vragenlijst voor Gedragsproblemen bij Kinderen (VvGK). Nederlandse bewerking van de Disruptive Behavior Disorders Rating Scale [Dutch translation of the Disruptive Behavior Disorders Rating Scale]

    (2000)
  • Cited by (0)

    Supported by an unrestricted research grant from Danone Friederichsdorf, Germany, which had no involvement in (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication. R.v.E. is an employee of Danone Research, Centre for Specialised Nutrition. The other authors declare no conflicts of interest.

    View full text