Predicting long-term neurodevelopmental outcomes for children born very preterm: a systematic review

Context Children born very preterm (<32 weeks’ gestation) have increased risk of neurodevelopmental difficulties compared with those born at term. While various neonatal exposures have been linked with later developmental challenges, identifying those at risk of difficulties later in childhood remains a challenge but is essential for targeting early intervention and counselling families. Objective To systematically review and synthesise the evidence regarding early medical and environmental factors for neurodevelopmental impairment, cognitive, motor and behavioural outcomes for children born very preterm. Design Ovid MEDLINE, Embase and PubMed were searched for articles between 1 January 1990 and 29 April 2024 reporting on a representative, prospective geographical, network-based or multisite cohorts of children born <32 weeks’ gestation. Main outcome measures Neurodevelopmental impairment, cognitive, motor and emotional-behavioural functioning in children aged 36 months to 18 years. Data were extracted and reported descriptively due to heterogeneity in study measures. Results From 18 012 records, 29 studies from 16 cohorts were included. Brain injury, bronchopulmonary dysplasia, male sex and lower socioeconomic status were the most consistent predictors of neurodevelopmental impairment, IQ, working memory, cerebral palsy, fine motor skills and some behavioural measures. Emotional problems were generally not associated with neonatal variables investigated to date. Conclusion Numerous factors are independently associated with childhood outcomes after being born very preterm, with specific predictors varying across domains of functioning and limited available evidence for some predictor-outcome combinations. Knowledge of these factors may assist in targeting those at highest risk for closer surveillance and early intervention. PROSPERO registration number CRD42022368957