Executive Functions and Academic Outcomes of Low Birthweight Infants: A Prospective Longitudinal U.S. Cohort

Sarah E. Miller; Mark D. DeBoer; Rebecca J. Scharf

doi:10.1055/s-0039-1700858

American Journal of Perinatology, Table of Contents

Am J Perinatol 2021; 38(06): 602-608
DOI: 10.1055/s-0039-1700858

Original Article

Executive Functions and Academic Outcomes of Low Birthweight Infants: A Prospective Longitudinal U.S. Cohort

Sarah E. Miller

¹Division of Neonatology, Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia

,

Mark D. DeBoer

²Division of Pediatric Diabetes and Endocrinology, Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia

,

Rebecca J. Scharf

³Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia

› Author Affiliations

Abstract

Objective Executive functions such as working memory and cognitive flexibility are key to lifelong learning. Our hypothesis was that children born low birthweight (LBW), defined as weight < 2,500 g, would have lower cognitive outcomes than those born normal weight, and children with poor executive functioning would be at risk for poor academic outcomes.

Study Design We evaluated data from 12,656 children followed prospectively in the Early Childhood Longitudinal Study, Kindergarten Class 2010–2011, assessing outcomes from kindergarten, first grade, and second grade. Multivariable linear and logistic regressions were run evaluating the relationship between birthweight and cognitive outcomes, and the odds of infants with poor executive functioning having poor academic outcomes.

Results Compared with children with normal birthweight, those born LBW had lower mean z-scores for academic and directly assessed executive functions from kindergarten through second grade. LBW children were at an increased risk of scoring in the bottom 20% of children at all time points: second-grade reading odds ratio (OR) = 1.60 (95% confidence interval [CI:] 1.23–2.09), math OR = 1.49 (95% CI: 1.21–1.84), science OR = 1.41 (95% CI: 1.11–1.81), cognitive flexibility OR = 1.61 (95% CI: 1.27–2.02), and working memory OR = 1.40 (95% CI: 1.10–1.77).

Conclusion LBW infants remain at risk of poor cognitive outcomes in second grade. Early difficulties with executive functioning can increase the risk of a child's academic performance years later.

Keywords

low birthweight - executive function - developmental outcomes - school-aged children

Full Text

References

References
1 Shah P, Kaciroti N, Richards B, Oh W, Lumeng JC. Developmental outcomes of late preterm infants from infancy to kindergarten. Pediatrics 2016; 138 (02) e20153496
2 Weindrich D, Jennen-Steinmetz C, Laucht M, Schmidt MH. Late sequelae of low birthweight: mediators of poor school performance at 11 years. Dev Med Child Neurol 2003; 45 (07) 463-469
3 Dawson P, Guare R. Smart but Scattered: The Revolutionary “Executive Skills” Approach to Helping Kids Reach Their Potential. New York, NY: The Guilford Press; 2009
4 Richland LE, Burchinal MR. Early executive function predicts reasoning development. Psychol Sci 2013; 24 (01) 87-92
5 Eryigit Madzwamuse S, Baumann N, Jaekel J, Bartmann P, Wolke D. Neuro-cognitive performance of very preterm or very low birth weight adults at 26 years. J Child Psychol Psychiatry 2015; 56 (08) 857-864
6 Hack M, Flannery DJ, Schluchter M, Cartar L, Borawski E, Klein N. Outcomes in young adulthood for very-low-birth-weight infants. N Engl J Med 2002; 346 (03) 149-157
7 McCloskey G, Perkins LA, Van Divner B. Assessment and Intervention for Executive Function Difficulties. New York, NY: Rout ledge Taylor & Frances; 2009
8 Grunewaldt KH, Skranes J, Brubakk AM, Lähaugen GC. Computerized working memory training has positive long-term effect in very low birthweight preschool children. Dev Med Child Neurol 2016; 58 (02) 195-201
9 Grunewaldt KH, Løhaugen GC, Austeng D, Brubakk AM, Skranes J. Working memory training improves cognitive function in VLBW preschoolers. Pediatrics 2013; 131 (03) e747-e754
10 Aarnoudse-Moens CS, Weisglas-Kuperus N, van Goudoever JB, Oosterlaan J. Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics 2009; 124 (02) 717-728
11 Anderson PJ, Doyle LW. ; Victorian Infant Collaborative Study Group. Executive functioning in school-aged children who were born very preterm or with extremely low birth weight in the 1990s. Pediatrics 2004; 114 (01) 50-57
12 Miller SE, DeBoer MD, Scharf RJ. Executive functioning in low birth weight children entering kindergarten. J Perinatol 2018; 38 (01) 98-103
13 O'Sullivan JJ, Pearce MS, Parker L. Parental recall of birth weight: how accurate is it?. Arch Dis Child 2000; 82 (03) 202-203
14 Walton KA, Murray LJ, Gallagher AM, Cran GW, Savage MJ, Boreham C. Parental recall of birthweight: a good proxy for recorded birthweight?. Eur J Epidemiol 2000; 16 (09) 793-796
15 Tourangeau K, Nord C, Lê T, Wallner-Allen K, Vaden-Kiernan N, Blaker L, Najarian M. Early Childhood Longitudinal Study, Kindergarten Class of 2010–11 (ECLS-K:2011) User’s Manual for the ECLS-K: 2011 Kindergarten–Second Grade Data File and Electronic Codebook, Public Version (NCES 2017-285). U.S. Department of Education. Washington, DC: National Center for Education Statistics; 2017
16 Farooqi A, Adamsson M, Serenius F, Hägglöf B. Executive functioning and learning skills of adolescent children born at fewer than 26 weeks of gestation. PLoS One 2016; 11 (03) e0151819
17 Ford RM, Neulinger K, O'Callaghan M, Mohay H, Gray P, Shum D. Executive function in 7-9-year-old children born extremely preterm or with extremely low birth weight: effects of biomedical history, age at assessment, and socioeconomic status. Arch Clin Neuropsychol 2011; 26 (07) 632-644
18 Baron IS, Kerns KA, Müller U, Ahronovich MD, Litman FR. Executive functions in extremely low birth weight and late-preterm preschoolers: effects on working memory and response inhibition. Child Neuropsychol 2012; 18 (06) 586-599
19 Ni TL, Huang CC, Guo NW. Executive function deficit in preschool children born very low birth weight with normal early development. Early Hum Dev 2011; 87 (02) 137-141
20 Orchinik LJ, Taylor HG, Espy KA. et al. Cognitive outcomes for extremely preterm/extremely low birth weight children in kindergarten. J Int Neuropsychol Soc 2011; 17 (06) 1067-1079
21 Horwood LJ, Mogridge N, Darlow BA. Cognitive, educational, and behavioural outcomes at 7 to 8 years in a national very low birthweight cohort. Arch Dis Child Fetal Neonatal Ed 1998; 79 (01) F12-F20
22 O'Callaghan MJ, Burns YR, Gray PH. et al. School performance of ELBW children: a controlled study. Dev Med Child Neurol 1996; 38 (10) 917-926
23 Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA 2002; 288 (06) 728-737
24 Böhm B, Smedler AC, Forssberg H. Impulse control, working memory and other executive functions in preterm children when starting school. Acta Paediatr 2004; 93 (10) 1363-1371
25 Twilhaar ES, Wade RM, de Kieviet JF, van Goudoever JB, van Elburg RM, Oosterlaan J. Cognitive outcomes of children born extremely or very preterm since the 1990s and associated risk factors: a meta-analysis and meta-regression. JAMA Pediatr 2018; 172 (04) 361-367
26 Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2014. Natl Vital Stat Rep 2015; 64 (12) 1-64
27 Bull R, Espy KA, Wiebe SA. Short-term memory, working memory, and executive functioning in preschoolers: longitudinal predictors of mathematical achievement at age 7 years. Dev Neuropsychol 2008; 33 (03) 205-228
28 Latzman RD, Elkovitch N, Young J, Clark LA. The contribution of executive functioning to academic achievement among male adolescents. J Clin Exp Neuropsychol 2010; 32 (05) 455-462
29 Andersson U. Working memory as a predictor of written arithmetical skills in children: the importance of central executive functions. Br J Educ Psychol 2008; 78 (Pt 2): 181-203
30 Espy KA, McDiarmid MM, Cwik MF, Stalets MM, Hamby A, Senn TE. The contribution of executive functions to emergent mathematic skills in preschool children. Dev Neuropsychol 2004; 26 (01) 465-486
31 Clark CAC, Pritchard VE, Woodward LJ. Preschool executive functioning abilities predict early mathematics achievement. Dev Psychol 2010; 46 (05) 1176-1191
32 Buschkuehl M, Hernandez-Garcia L, Jaeggi SM, Bernard JA, Jonides J. Neural effects of short-term training on working memory. Cogn Affect Behav Neurosci 2014; 14 (01) 147-160
33 Schwarb H, Nail J, Schumacher EH. Working memory training improves visual short-term memory capacity. Psychol Res 2016; 80 (01) 128-148
34 Weicker J, Villringer A, Thöne-Otto A. Can impaired working memory functioning be improved by training? A meta-analysis with a special focus on brain injured patients. Neuropsychology 2016; 30 (02) 190-212
35 Lee CS, Pei J, Andrew GA, Kerns K, Rasmussen C. Effects of working memory training on children born preterm. Appl Neuropsychol Child 2017; 6 (04) 281-296
36 Guare R, Dawson P. Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention. New York, NY: Guilford Press; 2010

Supplementary Material

Supplementary Material