Executive Function in Children Born Moderate-to-Late Preterm: A Meta-Analysis

Context: The risk of early neurodevelopmental delay is increasingly recognized in children born moderate-to-late preterm (MLP; 32-36 weeks' gestation), but school-aged cognitive outcomes are unclear, particularly for domains such as executive function (EF).

Objective: To evaluate EF outcomes (attentional control, cognitive flexibility, and goal setting) in school-aged children born MLP compared with children born at term.

Data sources: Medline, Embase, PsycInfo, and Scopus.

Study selection: Studies assessing EF outcomes (overall EF, attentional control, cognitive flexibility, and goal setting) in children born MLP aged between 6 and 17 years, which included a term-born control group.

Data extraction: Two reviewers screened for eligibility and completed the risk of bias assessment using the Newcastle-Ottawa Scale, and 1 reviewer extracted data. Random effects meta-analyses were performed.

Results: Twelve studies were eligible for inclusion in the meta-analyses (2348 MLP children and 20 322 controls). Children born MLP had poorer overall EF compared with children born at term (standardized mean difference, -0.15, 95% confidence interval, -0.21 to -0.09; P < .0001; I2 = 47.59%). Similar conclusions were noted across the subdomains of attentional control, cognitive flexibility, and goal setting.

Limitations: Study methodologies and EF measures varied. Only a small number of studies met eligibility criteria and were from developed countries.

Conclusions: School-aged children born MLP may experience greater challenges in EF compared with term-born children. Further research is needed to investigate the potential impact these challenges have on functional outcomes such as academic achievement and social-emotional functioning.