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Frontiers of Medicine

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Front. Med.    2018, Vol. 12 Issue (2) : 164-173    https://doi.org/10.1007/s11684-017-0540-9
RESEARCH ARTICLE
Comparison in executive function in Chinese preterm and full-term infants at eight months
Yao Feng1, Hong Zhou1, Yan Zhang1, Anthony Perkins2, Yan Wang1(), Jing Sun2,3()
1. Department of Child, Adolescent and Women’s Health, School of Public Health, Peking University, Beijing 100191, China
2. Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, QLD 4222, Australia
3. School of Medicine, Griffith University, Gold Coast, Queensland, QLD 4222, Australia
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Abstract

Executive function (EF) is increasingly recognized as being responsible for adverse developmental outcomes in preterm-born infants. Several perinatal factors may lead to poor EF development in infancy, and the deficits in EF can be identified in infants as young as eight months. A prospective cohort study was designed to study the EF in Chinese preterm infants and examine the relationship between EF in preterm infants and maternal factors during perinatal period. A total of 88 preterm infants and 88 full-term infants were followed from birth to eight months (corrected age). Cup Task and Planning Test was applied to assess the EF of infants, and the Bayley Scale of Infant Development (BSID-III) was used to evaluate cognitive (MDI) and motor abilities (PDI) of infants. In comparison with full-term infants, the preterm infants performed more poorly on all measures of EF including working memory, inhibition to prepotent responses, inhibition to distraction, and planning, and the differences remained after controlling the MDI and PDI. Anemia and selenium deficiency in mothers during pregnancy contributed to the differences in EF performance. However, maternal depression, hypertension, and diabetes during pregnancy were not related to the EF deficits in preterm infants. Future research should focus on the prevention of anemia and selenium deficiency during pregnancy and whether supplementing selenium in mothers during pregnancy can prevent further deterioration and the development of adverse outcomes of their offspring.
Keywords executive function (EF)      preterm infant      working memory      inhibition to prepotent response      inhibition to distraction      planning     
Corresponding Author(s): Yan Wang,Jing Sun   
Just Accepted Date: 16 May 2017   Online First Date: 19 June 2017    Issue Date: 02 April 2018
 Cite this article:   
Yao Feng,Hong Zhou,Yan Zhang, et al. Comparison in executive function in Chinese preterm and full-term infants at eight months[J]. Front. Med., 2018, 12(2): 164-173.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0540-9
https://academic.hep.com.cn/fmd/EN/Y2018/V12/I2/164
Fig.1  Arrangement of the test room and toys used in the EF task.
Number of cups Delay time between hiding and reaching (s) Sequence of the trails in each time delay
1 2 3 4 5 6 7 8 9
1 cup 0 L L L
4 L L L
10 L L L
2 cups 0 L L L R R R L L L
2 R R R L L L R R R
4 L L L R R R L L L
10 R R R L L L R R R
3 cups 0 L L L R R R L L L
2 R R R L L L R R R
4 L L L R R R L L L
10 R R R L L L R R R
Tab.1  Infant working memory and inhibition task
Fig.2  Step one of the planning task (pull a cloth; retrieve the toy).
Fig.3  Step two of the planning task (remove an obstacle; pull a cloth; retrieve the toy).
Fig.4  Step three of the planning task (remove an obstacle; pull a cloth; pull a string; retrieve the toy).
Variables Preterm infants (n = 88) Full-term infants (n = 88) t or c2 P
Sex of child
?Male, n (%)		 44 (50.0) 44 (50.0) ?<?0.001 1.000
Maternal age
?Mean (SD) (year)		 30.47 (4.63) 30.33 (3.45) 0.222 0.825
Maternal education
?Grade≤12, n (%)
?Grade>12, n (%)		 10 (11.4)
78 (88.6)		 5 (5.7)
83 (94.3)		 1.822 0.177
Family annual income per capita (CNY)
?30 000 and less, n (%)
?30 000–59 999, n (%)
?60 000 and above, n (%)		 36 (40.9)
31 (35.2)
21 (23.9)		 25 (28.4)
33 (37.5)
30 (34.1)		 3.634 0.162
Maternal psychological well-being (EPDS scores)
?Score?<?9.5, n (%)
?Score≥9.5, n (%)		 80 (90.9)
8 (9.1)		 80 (90.9)
8 (9.1)		 ?<?0.001 1.000
Bayley Cognitive
?Mean (SD)		 103.75 (8.17) 106.25 (8.52) –1.987 0.049
Bayley Motor
?Mean (SD)		 98.23 (8.67) 102.51 (8.04) –3.398 0.001
Tab.2  Characteristics of the preterm and full-term infant groups
Variables Preterm infants (n = 88) Full-term infants (n = 88) Unadjusted model Adjusted model
F P F P
1. Working memory, mean (SD) 3.80 (4.57) 7.98 (5.38) 30.833 ?<?0.001 23.009 ?<?0.001
2. Distraction, mean (SD) 0.39 (0.24) 0.29 (0.20) 8.978 0.003 6.173 0.014
3. Inhibition, mean (SD) 0.35 (0.60) 0.80 (0.70) 20.527 ?<?0.001 15.165 ?<?0.001
4. Planning, mean (SD) 11.44 (10.60) 17.56 (11.67) 13.231 ?<?0.001 9.512 0.002
Tab.3  Executive function scores for preterm and full-term infants at 8 months corrected age
Variables 28–31 weeks (n = 9) 32–36 weeks (n = 79) t P
1. Working memory, mean (SD) 3.78 (5.36) 3.80 (4.52) –0.012 0.990
2. Distraction, mean (SD) 0.40 (0.31) 0.39 (0.23) 0.202 0.840
3. Inhibition, mean (SD) 0.45 (0.92) 0.34 (0.55) 0.352 0.733
4. Planning, mean (SD) 11.67 (10.95) 11.42 (10.63) 0.066 0.947
Tab.4  Executive function scores at 8 months corrected age for preterm infants 28–31 weeks gestation and 32–36 weeks gestation
Variables 1000–1499 g birth weight
(n = 11)		 1500–2499 g birth weight
(n = 53)		 t P
1. Working memory, mean (SD) 3.36 (4.06) 4.21 (5.02) –0.523 0.603
2. Distraction, mean (SD) 0.34 (0.27) 0.39 (0.26) –0.567 0.573
3. Inhibition, mean (SD) 0.50 (0.72) 0.36 (0.61) 0.665 0.509
4. Planning, mean (SD) 10.73 (8.58) 10.62 (10.92) 0.030 0.976
Tab.5  Executive function scores at 8 months corrected age for low birth weight infants with birth weights of 1000–1499 g and 1500–2499 g
Variables Preterm infants (n = 88)
Hypertension during pregnancy, n (%)
?Yes
?No		 23 (26.4)
64 (73.6)
Diabetes, n (%)
?Yes
?No		 20 (22.7)
68 (77.3)
Selenium (ng/ml)
?Mean (SD)		 60.20 (10.33)
Anemia, n (%)
?Yes
?No		 66 (75.9)
21 (24.1)
Tab.6  Maternal factors of preterm infants
Variables Working memory Distraction Inhibition Planning
B (95%CI) P B (95%CI) P B (95%CI) P B (95%CI) P
Hypertension 1.53 (–0.66 to 3.71) 0.17 –0.005 (–0.12 to 0.11) 0.94 0.22 (–0.07 to 0.52) 0.14 –1.84 (–7.25 to 3.56) 0.50
Diabetes –1.99 (–4.34 to 0.35) 0.09 0.10 (–0.02 to 0.22) 0.11 –0.13 (–0.45 to 0.19) 0.42 –0.64 (–6.46 to 5.78) 0.83
Selenium 0.12 (0.02 to 0.22) 0.02 –0.004 (–0.009 to 0.001) 0.11 0.01 (–0.001 to 0.03) 0.06 –0.12 (–0.36 to 0.13) 0.36
Anemia 3.09 (0.86 to 5.32) 0.001 −0.19 (–0.31 to –0.07) 0.002 0.46 (0.16 to 0.76) 0.003 3.99 (–1.53 to 9.51) 0.15
R square 15.5% 15.4% 14.3% 5.9%
Adjusted R square 10.8% 10.7% 9.5% 0.7%
ANOVA F 3.31 3.28 3.00 1.12
ANOVA P 0.01 0.02 0.02 0.35
Tab.7  Multiple linear regression (preterm infants)
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