Executive function profiles in survivors of neonatal critical illness - a latent profile analysis in school-aged children born very preterm or with complex congenital heart disease and in typically developing peers.

Abstract

Executive function (EF) impairments are prevalent in survivors of neonatal critical illness such as children born very preterm (VPT) or with complex congenital heart disease (cCHD). This paper aimed to describe EF profiles in school-aged children born VPT or with cCHD and in typically developing peers, to identify child-specific and family-environmental factors associated with these profiles and to explore links to everyday-life outcomes. Data from eight EF tests assessing working memory, inhibition, cognitive flexibility, switching, and planning in n = 529 children aged between 7 and 16 years was subjected into a latent profile analysis. Three EF profiles were identified: The "favorable" profile was defined by mean scores in the normal range (z-scores ≤ -0.5 below the norm; n = 263, 49.7%). The "at-risk" profile's mean scores were 0.5 to 1 SD below the norm (n = 236, 44.6%). The "impaired" profile's mean scores were >1 SD below the norm (n = 30, 5.8%). Children of the two clinical groups were more likely to fall into the at-risk or impaired profile. Irrespective of clinical group, lower socioeconomic status, slower processing speed and poorer fine motor skills were associated with a more impaired profile. In turn, falling into the at-risk or impaired profile was associated with a higher need for educational support, poorer everyday-life EFs and more behavioral problems. Children in the impaired profile reported lower psychosocial quality of life. This study provides evidence for an increased risk of survivors of neonatal critical illness to present with an impaired EF profile that translates into everyday-life difficulties. Long-term monitoring is needed to promote optimal outcome.