INS NYC 2024 Program

Poster	Poster Session 10 Program Schedule 02/17/2024 09:00 am - 10:15 am Room: Shubert Complex (Posters 1-60) Poster Session 10: Neurodevelopmental \| Congenital Conditions Final Abstract #44 Early Predictors of Longitudinal Change in Executive Functions in Extremely Low Gestational Age Newborns from Ages 2 to 15 Years Stephen Hooper, University of North Carolina-Chapel Hill, Chapel Hill, United States Robert Joseph, Boston University Chobanian and Avedisian School of Medicine, Boston, United States Hudson Santos, University of Miami, Miami, United States Frank Gutierrez, University of Miami, Miami, United States Xianming Tan, University of North Carolina-Chapel Hill, Chapel Hill, United States Jean Frazier, University of Massachusetts Medical School, Worcester, United States Karl Kuban, Boston Medical Center, Boston, United States Rachana Singh, Tufts Medical Center, Boston, United States Michael Msall, University of Chicago, Chicago, United States Rebecca Fry, University of North Carolina-Chapel Hill, Chapel Hill, United States T O'Shea, University of North Carolina-Chapel Hill, Chapel Hill, United States Category: Executive Functions/Frontal Lobes Keyword 1: executive functions Keyword 2: prematurity Keyword 3: pediatric neuropsychology Objective: Children born extremely preterm are at-risk for executive function (EF) deficits over and above the risk for lower general cognitive ability. These deficits can negatively impact both learning and social functioning. This study poses two research questions: (1) How do EFs (working memory, cognitive flexibility, inhibitory control, global EF) change over time across ages 2, 10, and 15 years? (2) Which specific early factors may help predict these changes over time? Participants and Methods: Participants included 665 individuals from the ELGAN Study (Extremely Low Gestational Age Newborns) (i.e., 23-27 weeks). All participants had at least two EF measures across ages 2, 10, and 15 years, representing over 1,600 visits. The sample was 50.8% male and 66.3% White, with 59.7% of mothers having more than a high school education. Targeted outcomes included the Child Behavior Checklist Dysregulation Profile (DP), a global indicator of executive dysfunction at age 2; the DAS-II and NEPSY-II measures of working memory (DAS Working Memory), inhibitory control (NEPSY-II Inhibition Inhibition), and cognitive flexibility (NEPSY-II Inhibition Switching) at age 10; and the NIH Toolbox Cognitive Battery for measures of working memory (List Sorting), inhibitory control (Flanker), and cognitive flexibility (Card Sort) at age 15. For ages 10 and 15, we combined test scores to create an EF composite (global EF). Early predictors included socioeconomic status (SES), newborn characteristics, neonatal comorbidities (e.g., white matter damage-WMD), circulating inflammatory markers, and the presence of the Dysregulation Profile at age 2. Linear mixed effects models, including interactions, were used to examine the four EF outcomes. Results: Over the 13-year time period, unadjusted analyses showed EFs changed significantly and differentially. All EFs declined from age 2 to age 10 to a below average range. Working memory showed minor positive gains from age 10 to age 15, while cognitive flexibility rebounded at age 15 into the average range. Inhibitory control continued to decline into the impaired range. In adjusted analyses, significant predictors of poorer development/decline of EF over the 13-year time span included WMD and need for ventilation/oxygen for each EF dimension. Lower gestational age (23-24 weeks) was a significant predictor of lower working memory (p < .001), cognitive flexibility (p < .03), and global EF (p < .006). Presence of the DP at age 2 had a nonsignificant impact on change. Significant interactions were present between SES and chronological age for each of the EFs; i.e., the lower SES at age 2, the lower the EF over the 13-year time period. Effects sizes were small to moderate in magnitude. Conclusions: In one of the largest longitudinal studies tracking ELGANs into adolescence, results demonstrate differential developmental profiles for each EF, with specific medical and biological factors being predictive of EF changes over time. SES at age 2 years also interacted with chronological age to impact outcomes for each of the EFs over time. Hence, for children born extremely premature and at-risk for EF difficulties (particularly inhibitory control) there is a critical need for early identification and developing specific intervention strategies.

Poster

02/17/2024
09:00 am - 10:15 am
Room: Shubert Complex (Posters 1-60)

Poster Session 10: Neurodevelopmental | Congenital Conditions

Final Abstract #44

Early Predictors of Longitudinal Change in Executive Functions in Extremely Low Gestational Age Newborns from Ages 2 to 15 Years

Stephen Hooper, University of North Carolina-Chapel Hill, Chapel Hill, United States
Robert Joseph, Boston University Chobanian and Avedisian School of Medicine, Boston, United States
Hudson Santos, University of Miami, Miami, United States
Frank Gutierrez, University of Miami, Miami, United States
Xianming Tan, University of North Carolina-Chapel Hill, Chapel Hill, United States
Jean Frazier, University of Massachusetts Medical School, Worcester, United States
Karl Kuban, Boston Medical Center, Boston, United States
Rachana Singh, Tufts Medical Center, Boston, United States
Michael Msall, University of Chicago, Chicago, United States
Rebecca Fry, University of North Carolina-Chapel Hill, Chapel Hill, United States
T O'Shea, University of North Carolina-Chapel Hill, Chapel Hill, United States

Category: Executive Functions/Frontal Lobes

Keyword 1: executive functions
Keyword 2: prematurity
Keyword 3: pediatric neuropsychology

Objective:

Children born extremely preterm are at-risk for executive function (EF) deficits over and above the risk for lower general cognitive ability. These deficits can negatively impact both learning and social functioning. This study poses two research questions: (1) How do EFs (working memory, cognitive flexibility, inhibitory control, global EF) change over time across ages 2, 10, and 15 years? (2) Which specific early factors may help predict these changes over time?

Participants and Methods:

Participants included 665 individuals from the ELGAN Study (Extremely Low Gestational Age Newborns) (i.e., 23-27 weeks). All participants had at least two EF measures across ages 2, 10, and 15 years, representing over 1,600 visits. The sample was 50.8% male and 66.3% White, with 59.7% of mothers having more than a high school education. Targeted outcomes included the Child Behavior Checklist Dysregulation Profile (DP), a global indicator of executive dysfunction at age 2; the DAS-II and NEPSY-II measures of working memory (DAS Working Memory), inhibitory control (NEPSY-II Inhibition Inhibition), and cognitive flexibility (NEPSY-II Inhibition Switching) at age 10; and the NIH Toolbox Cognitive Battery for measures of working memory (List Sorting), inhibitory control (Flanker), and cognitive flexibility (Card Sort) at age 15. For ages 10 and 15, we combined test scores to create an EF composite (global EF). Early predictors included socioeconomic status (SES), newborn characteristics, neonatal comorbidities (e.g., white matter damage-WMD), circulating inflammatory markers, and the presence of the Dysregulation Profile at age 2. Linear mixed effects models, including interactions, were used to examine the four EF outcomes.

Results:

Over the 13-year time period, unadjusted analyses showed EFs changed significantly and differentially. All EFs declined from age 2 to age 10 to a below average range. Working memory showed minor positive gains from age 10 to age 15, while cognitive flexibility rebounded at age 15 into the average range. Inhibitory control continued to decline into the impaired range. In adjusted analyses, significant predictors of poorer development/decline of EF over the 13-year time span included WMD and need for ventilation/oxygen for each EF dimension. Lower gestational age (23-24 weeks) was a significant predictor of lower working memory (p < .001), cognitive flexibility (p < .03), and global EF (p < .006). Presence of the DP at age 2 had a nonsignificant impact on change. Significant interactions were present between SES and chronological age for each of the EFs; i.e., the lower SES at age 2, the lower the EF over the 13-year time period. Effects sizes were small to moderate in magnitude.

Conclusions:

In one of the largest longitudinal studies tracking ELGANs into adolescence, results demonstrate differential developmental profiles for each EF, with specific medical and biological factors being predictive of EF changes over time. SES at age 2 years also interacted with chronological age to impact outcomes for each of the EFs over time. Hence, for children born extremely premature and at-risk for EF difficulties (particularly inhibitory control) there is a critical need for early identification and developing specific intervention strategies.