Childhood Neglect and Cognitive Development in Extremely Low Birth Weight Infants: A Prospective Study

Abstract

Objective. To examine the relationship between child maltreatment and cognitive development in extremely low birth weight infants, adjusting for perinatal and parental risk factors. Methods. A total of 352 infants with birth weight of <1000 g were followed prospectively for 4 years. The data were analyzed with regard to perinatal and parental risk factors and referrals for suspected child maltreatment to government agencies. Perinatal risk factors included birth weight, gestation, gender, periventricular hemorrhage, ventricular dilation, home oxygen requirement, and necrotizing enterocolitis. Parental risk factors included maternal age, race, marital status, education, and hospital insurance status. Cognitive z scores were calculated at 1, 2, and 4 years, and head circumference z scores were calculated at birth, 2 years, and 4 years. Results. Fifteen percent of infants were referred to child protective services for suspected child maltreatment. The adjusted general cognitive index at 4 years was significantly reduced in infants who were referred for neglect (−17.6; 95% confidence interval: −3.3, −31.9). Infants whose neglect was substantiated had a progressive decline in their cognitive function over time (cognitivez scores: −0.97, −1.37, and −2.05 standard deviations at 1, 2, and 4 years, respectively), compared with non-neglected infants (z scores: −0.04 to −0.36). They had a significantly smaller head circumference at 2 and 4 years but not at birth (adjusted z score at 4 years: −0.812; 95% confidence interval: −0.167, −1.458). Perinatal risk factors and physical disability were not related to maltreatment referral; only parental factors were independent predictors. Conclusions. Childhood neglect is associated significantly with delayed cognitive development and head growth. Addressing risk factors antenatally and in early childhood may improve outcomes.