How Early Is Too Early?

Research Article| September 01 2025 How Early Is Too Early? Available to Purchase AAP Grand Rounds (2025) 54 (3): 35. https://doi.org/10.1542/gr.54-3-35 Views Icon Views Open Menu Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook X LinkedIn Email Tools Icon Tools Open Menu Get Permissions Cite Icon Cite Search Site Citation How Early Is Too Early?. AAP Grand Rounds September 2025; 54 (3): 35. https://doi.org/10.1542/gr.54-3-35 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: attention-deficit/hyperactivity disorder, autistic disorder, cognitive flexibility, executive functioning, medical devices, australia, toddler, white matter Source: Rossetti L, Pascoe L, Mainzer RM, et al. Executive function outcomes at school age in children born moderate-to-late preterm. J Pediatr. 2025:284:114634; doi: https://doi.org/10.1016/j.jpeds.2025.114634.Google Scholar Investigators from Murdoch Children's Research Institute and the University of Melbourne, both in Melbourne, Australia, conducted a study to assess the impact of moderate-to-late preterm (MLP) birth on executive function (EF) at school age. Study participants included a cohort of children with MLP birth, defined as birth at 32–36 weeks' gestation, and a cohort with uncomplicated term births (≥37 weeks' gestation). Demographic and clinical information were collected on these children. EF was assessed when study participants were approximately 9 years old using a variety of neurodevelopmental tests across 3 subdomains, including attentional control, cognitive flexibility, and goal setting. EF behaviors were evaluated using the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) global executive composite (GEC) score. Differences in EF function and behavior scores were compared between the MLP and term cohorts using regression analyses after adjusting for confounding. In addition, using threshold values to define impairment, the relative risk (RR) of impairment in EF function and behavior among children in the MLP cohort also was evaluated. The original cohort included 201 MLP children and 201 in the term cohort; 159 (79%) of those in the MLP group and 134 (67%) born at term were assessed at 9 years of age. Among these participants, those in the MLP cohort were more likely to have repeated a school year than those born at term (3.2% vs 0%) and have a diagnosis of attention-deficit hyperactivity disorder (11.1% vs 5.5%). When EF was assessed, there were no significant differences in scores between children in the 2 cohorts in the attentional control subdomain. However, for the cognitive flexibility subdomain, scores on the working memory task (digit span backwards test) were significantly worse among those in the MLP group than the term cohort (P = 0.02). The composite score for goal setting was also significantly lower in the MLP cohort than in children born at term (P = 0.03). Based on the composite score for the 3 subdomains, there was no significant difference between groups for risk of impairment. There was a significantly increased risk for impairment in working memory for those in the MLP group (RR, 1.80; 95% confidence interval [CI], 1.05, 3.09), and, in the goal setting subdomain, for visual-spatial reasoning and planning tasks (block design test; RR, 1.69; 95% CI, 1.08, 2.65). There also was an increased risk in MLP children for impairment in EF behaviors as assessed with the GEC (RR, 1.86; 95% CI, 1.05, 3.27). The authors conclude that children with MLP birth had a pattern of EF difficulties when assessed at school. Dr Badawi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Previous researchers have indicated that MLP infants are at... You do not currently have access to this content.