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Major amendments in neonatal care have been introduced in recent decades. It is important to understand whether these amendments improved the cognitive sequelae of preterm children. Through a large-scale meta-analysis, we explored the association between prematurity-related complications, neonatal care quality, and cognitive development from birth until 7 years. MEDLINE, APA PsycInfo, and EBSCO were searched. Peer-reviewed studies published between 1970 and 2022 using standardized tests were included. We evaluated differences between preterm and full-term children in focal developmental domains using random-effects meta-analyses. We analyzed data from 161 studies involving 39,799 children. Preterm birth was associated with inferior outcomes in global cognitive development (standardized mean difference = -0.57, 95% CI -0.63, -0.52), as well as in language/communication, visuospatial, and motor performance, reflecting mean decreases of approximately 7.3 to 9.3 developmental/intelligence quotients. Extreme prematurity, neonatal pulmonary morbidities, and older assessment age in very-to-extreme preterm cohorts were associated with worse outcomes. Contemporary neonatal medical and developmental care were associated with transient improvements in global cognitive development, evident until 2 to 3 years of age but not after. Blinding of examiners to participants' gestational background was associated with poorer outcomes in preterm cohorts, suggesting the possibility of a "compassion bias." The results suggest that preterm birth remains associated with poorer cognitive development in early childhood, especially following pulmonary diseases and very-to-extreme preterm delivery. Importantly, deficits become more pervasive with age, but only after births before 32 gestational weeks and not in moderate-to-late preterm cohorts. Care advancements show promising signs of promoting resiliency in the early years but need further refinements throughout childhood. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Burstein et al. (Thu,) studied this question.