Early predictors of cognitive trajectories from birth to adolescence in children born extremely preterm

AIM: To predict trajectories of cognitive abilities from ages 2 years to 15 years in children born extremely preterm. METHOD: This longitudinal cohort study examined 659 (330 males) children born at 23 weeks to 27 weeks' gestation with cognitive assessments at ages 2 years, 10 years, and 15 years. Early factors analysed included maternal and neonatal characteristics, comorbidities, and neonatal inflammatory proteins. RESULTS: For verbal, non-verbal, and combined cognitive abilities, greater social disadvantage at birth, male sex, 23 weeks to 24 weeks gestational age, bronchopulmonary dysplasia (BPD), ultrasound-detected cerebral white matter injury (WMI), and elevated inflammatory proteins in neonatal blood were associated with lower scores over the 15-year time frame for all outcomes. Analyses of joint association between socially disadvantaged groups and WMI suggested that the effect of no social disadvantage was evident only among children without WMI, whereas the effect of WMI was evident irrespective of social disadvantage. INTERPRETATION: In this cohort of children born extremely preterm, social disadvantage at birth, male sex, BPD, WMI, and neonatal systemic inflammation were associated with slower gains in cognitive scores from age 2 years to 15 years. Early WMI moderated the associations between social disadvantage and cognitive functioning. Efforts to address both neonatal morbidities and social factors could improve cognitive functioning in children born extremely preterm.