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J Int Neuropsychol Soc. 2019 Apr;25(4):362-374. doi: 10.1017/S1355617719000080.

Resilience in Extremely Preterm/Extremely Low Birth Weight Kindergarten Children.

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The Research Institute at Nationwide Children's Hospital,Center for Biobehavioral Health, andDepartment of Pediatrics,The Ohio State University,Columbus,Ohio.
Department of Pediatrics,Case Western Reserve University,and Rainbow Babies & Children's Hospital,University Hospitals Cleveland Medical Center,Cleveland,Ohio.
Department of Population and Quantitative Health Sciences,Case Western Reserve University,Cleveland,Ohio.
University of Texas at San Antonio,San Antonio,Texas.
Department of Teacher Education,Cleveland State University,Cleveland,Ohio.



Research on developmental outcomes of preterm birth has traditionally focused on adverse effects. This study investigated the prevalence and correlates of resilience in 146 extremely preterm/extremely low birth weight (EPT/ELBW) children (gestational age <28 weeks and/or birth weight <1000 g) attending kindergarten and 111 term-born normal birth weight (NBW) controls.


Adaptive competence (i.e., "resilience" in the EPT/ELBW group) was defined by scores within grade expectations on achievement tests and the absence of clinically elevated parent ratings of child behavior problems. The "adaptive" children who met these criteria were compared to the "maladaptive" children who did not on child and family characteristics. Additional analyses were conducted to assess the conjoint effects of group (ELBW vs. NBW) and family factors on adaptive competence.


A substantial minority of the EPT/ELBW group (45%) were competent compared to a majority of NBW controls (73%), odds ratio (95% confidence interval)=0.26 (0.15, 0.45), p<.001. Adaptive competence was associated with higher cognitive skills, more favorable ratings of behavior and learning not used to define adaptive competence, and more advantaged family environments in both groups, as well as with a lower rate of earlier neurodevelopmental impairment in the EPT/ELBW group. Higher socioeconomic status and more favorable proximal home environments were associated with competence independent of group, and group differences in competence persisted across the next two school years.


The findings document resilience in kindergarten children with extreme prematurity and highlight the role of environmental factors as potential influences on outcome. (JINS, 2019, 25, 362-374).


Cognitive function; Competence; Development; Environmental impact; Family; Premature birth

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