The risk of adverse neurodevelopmental outcomes is increasingly recognised in children born moderate-to-late preterm (MLP; 32-36 weeks’ gestation). The objective of the study was to evaluate outcomes in executive function (EF) subdomains (attentional control, cognitive flexibility, and goal setting), in school-aged children born MLP compared with children born at term.

Medline, Embase, PsycInfo, and Scopus were systematically searched for studies assessing EF outcomes in children aged 6-to-17 years old (spanning school age), who were born MLP, and a term control group. Studies were included if they assessed an EF skill within the subdomains of attentional control, cognitive flexibility, or goal setting.

6888 publications were screened, resulting in 12 studies eligible for meta-analysis (2472 MLP children and 17,175 controls, aged 6-to-14 years old). Overall, children born MLP demonstrated subtle, poorer EF performance compared with children born at term (standardised mean difference = -0.13, 95% CI = -0.18 to -0.08; p <.0001; I² = 21.08%). Performance on goal setting measures was consistently lower for MLP children compared with term (standardised mean difference = -0.14, 95% CI = -0.20 to -0.09), whilst less difference was evident for measures of cognitive flexibility (standardised mean difference = -0.07, 95% CI = -0.13 to -0.01). Studies assessing attentional control were limited.

Children born MLP may experience subtle weaknesses in EF compared to term born children. Further investigation of the subdomains of EF in this population is warranted.