Physician’s WeeklyDespite Advances, IQ Gap Persists Between Children Born Preterm & Term

This systematic review and meta-analysis of 257 studies spanning four decades (1977-2016) demonstrates that despite significant advances in perinatal care improving survival rates, children born very preterm continue to show persistent cognitive deficits compared to term-born children, with no improvement in IQ gaps over time.

⚕️ Key Clinical Considerations ⚕️

• Persistent cognitive deficit: Standardized mean difference in IQ scores between very preterm and term children remains unchanged across four decades despite medical advances.
• Survival paradox: Improved survival of extremely premature infants (23-25 weeks GA) may mask cognitive gains in less vulnerable populations due to inclusion of highest-risk survivors.
• Socioeconomic confounding: Preterm birth disproportionately affects socially vulnerable populations, creating complex interactions between biological and social determinants of cognitive outcomes.
• Methodological limitations: Short-term neonatal outcomes serve as poor proxies for long-term cognitive development, limiting intervention research and clinical decision-making.
• Follow-up system gaps: Inconsistent standardized follow-up programs across regions hinder both clinical care coordination and research data collection for evidence-based interventions.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Counsel families that although survival rates have dramatically improved, cognitive risks remain significant and consistent over time, requiring realistic expectation-setting and long-term developmental planning.
• Practice Integration: Implement standardized neurodevelopmental follow-up protocols using validated assessment tools to enable both optimal clinical care and research participation.
• Risk Management: Document comprehensive socioeconomic assessments and coordinate multidisciplinary care early to address modifiable risk factors affecting long-term cognitive outcomes.
• Action Items: Advocate for structured follow-up programs that combine clinical care with research opportunities, focusing on functional outcomes beyond traditional IQ measurements that matter most to families.

More in Pediatric Neurology