Stefani, Artemis; (2024) Executive Function through the first decade of life: the case of preterm birth. Doctoral thesis (Ph.D), UCL (University College London).

Text Artemis_Stefani_PhD_Thesis_submitted.pdf - Accepted Version Access restricted to UCL open access staff until 1 March 2026. Download (14MB)

Abstract

Preterm birth at ≤32 weeks of gestation has been associated with poor neurodevelopmental outcomes including difficulties in executive function (EF). Who will develop EF difficulties is however not well understood. Characterising factors associated with EF difficulties and how EF mediates socio-emotional and behavioural outcomes is critical to improving outcome prediction. In this work, preterm infants were recruited from University College Hospital (UCLH) in London UK, soon after birth. Infants were scanned with structural brain MRI at term-equivalent age and were followed up with neuropsychological assessment at 30 months, 4-5 years and 8-10 years as part of the UCH Preterm Development Project, alongside a full-term group. Statistical analyses within the preterm group were performed to identify early-life medical and neuroimaging variables that contribute to inter-individual EF variability. Cross-sectional and longitudinal contributions of EF on inattention, hyperactivity, behavioural, and socio-emotional regulation were investigated. Lastly, intra-individual variability of EF was assessed within each time point and as part of a longitudinal trajectory approach. Poorer performance in EF was identified within the preterm group at 30 months, 4-5 years and 8-10 years relative to the full-term children. EF performance was considerably more variable in preschool and school-age periods both between and within preterm participants relative to controls. Earlier EF performance of preterm participants was associated with later behavioural and emotional regulation and ADHD symptomatology. EF performance at each developmental time point was associated with cardiovascular, respiratory and structural brain morphological markers from birth. Findings demonstrate the need to prioritise the investigations of between- and within-preterm participants’ EF variability. Large inter-individual variability confirms that preterm birth affects neurodevelopment in a complex manner. Large intra-individual variability in EF performance in preterm children indicates a reduced positive manifold. Associations between EF and (a) early medical data, (b) brain imaging at birth and (c) later neurodevelopmental symptomatology highlight differential pathways to atypical development and demonstrate the constraints of plasticity mechanisms.

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