Executive functions of children born very preterm—deficit or delay?

• Published in: European journal of pediatrics Vol. 172; no. 4; pp. 473 - 483
• Main Authors: Ritter, Barbara Catherine, Nelle, Mathias, Perrig, Walter, Steinlin, Maja, Everts, Regula
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.04.2013; Springer Nature B.V
• Subjects: Age; Age groups; Birth weight; Case-Control Studies; Child; Child, Preschool; Executive function; Executive Function - physiology; Female; Humans; Hypotheses; Infant, Extremely Premature - physiology; Infant, Extremely Premature - psychology; Infant, Newborn; Infant, Very Low Birth Weight - physiology; Infant, Very Low Birth Weight - psychology; Inhibition (Psychology); Male; Medicine; Medicine & Public Health; Memory; Memory, Short-Term - physiology; Neuropsychological Tests; Original Article; Pediatrics; Statistics, Nonparametric; Switzerland; Switzerland; Shifting; Children; Working memory; Inhibition; Catch-up; Preterm
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-012-1906-2

This cross-sectional study examined the performance of children born very preterm and/or at very low birth weight (VPT/VLBW) and same-aged term-born controls in three core executive functions: inhibition, working memory, and shifting. Children were divided into two age groups according to the median (young, 8.00–9.86 years; old, 9.87–12.99 years). The aims of the study were to investigate whether (a) VPT/VLBW children of both age groups performed poorer than controls (deficit hypothesis) or caught up with increasing age (delay hypothesis) and (b) whether VPT/VLBW children displayed a similar pattern of performance increase in executive functions with advancing age compared with the controls. Fifty-six VPT/VLBW children born in the cohort of 1998–2003 and 41 healthy-term-born controls were recruited. All children completed tests of inhibition (Color-Word Interference Task, Delis–Kaplan Executive Function System (D-KEFS)), working memory (Digit Span Backwards, HAWIK-IV), and shifting (Trail Making Test, Number–Letter Sequencing, D-KEFS). Results revealed that young VPT/VLBW children performed significantly poorer than the young controls in inhibition, working memory, and shifting, whereas old VPT/VLBW children performed similar to the old controls across all three executive functions. Furthermore, the frequencies of impairment in inhibition, working memory and shifting were higher in the young VPT/VLBW group compared with the young control group, whereas frequencies of impairment were equal in the old groups. In both VPT/VLBW children and controls, the highest increase in executive performance across the ages of 8 to 12 years was observed in shifting, followed by working memory, and inhibition. Conclusions : This study provides evidence that (a) poor performance in inhibition, working memory, and shifting of young VPT/VLBW children might reflect a delay rather than a deficit and (b) that VPT/VLBW children are likely to display a similar pattern of performance increase in these three executive functions compared with that of controls.