Very preterm children showed no catch-up in executive function by 13

Design

Prospective longitudinal cohort

Population

224 children born before 30 weeks and 77 term controls

Primary outcome

Parent-rated executive function at 2, 5, 7 and 13 years

Effect

0.3–0.7 SD more difficulty at every age; no catch-up

The Victorian Infant Brain Study followed 224 children born before 30 weeks' gestation and 77 born at term in Melbourne, with parents rating executive function on a standard inventory at ages 2, 5, 7 and 13.

At every age and on every scale, very preterm children had more difficulty, by 0.3 to 0.7 standard deviations. The gap did not narrow over time. It tended to be larger in boys and in families with greater social disadvantage. Both groups followed similar developmental shapes, with planning and emotional control difficulties rising to age 7 and then levelling.

Many follow-up programmes stop at two years. These data suggest that difficulties with attention, planning and self-regulation persist into adolescence and need surveillance through the school years. The measures were parent-reported, and the cohort was born in the early 2000s, so current outcomes may differ somewhat.

• Continue developmental surveillance for children born very preterm beyond the second year, into school age.
• Ask parents and teachers specifically about attention, planning, organisation and emotional control.
• Consider early referral for educational and psychological support when difficulties appear.
• Give particular attention to boys and families facing social disadvantage.

Why it matters

A reassuring two-year check does not mean a very preterm child has caught up.

Don't overread it

Executive function was parent-rated, and the cohort was born two decades ago when neonatal care differed.

The statistics, in plain English

A difference of 0.3 to 0.7 standard deviations is small to moderate, but it was consistent across every scale and every age, which is what makes it clinically important.

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