Social development of children born very preterm: a systematic review

AimTo review systematically studies examining the development of social competence in children born very preterm (VPT) (gestation <33wks) and identify neonatal and family predictors. MethodPeer-reviewed original articles were extracted from PubMed and PsycINFO following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria included children born VPT and comparison children born at term, sample born after 1990, and children assessed between 0 and 17years on at least one measure of social competence spanning social adjustment, performance, and/or social skills. ResultsTwenty-three studies were included. Seven focused on social competence and another 16 examined social competence within a range of outcomes. Study quality was low. Limitations included reliance on single informant data, cross-sectional measurement, use of brief screening tools, absence of child or peer report, and no conceptual model. In terms of social adjustment, 16 out of 21 studies found children born VPT had more peer problems and social withdrawal. Findings of social performance were mixed, with some studies suggesting differences in prosocial behavior (4/14) and others not. Social skills were assessed in four studies and showed children born VPT had poorer skills than children born at term. Predictors of social competence included gestational age, neonatal brain abnormalities, and family socio-economic status. InterpretationChildren born VPT have poorer social competence. These difficulties emerge early and persist throughout childhood. What this paper adds Two out of seven primary social competence studies and three out of 16 with a more general focus were considered to have high quality methodology. Children born very preterm are at increased risk of social competence difficulties. These difficulties emerge early and persist throughout childhood. Social difficulties include more peer problems and social skill deficits. Predictors include extremely preterm birth, neonatal cerebral abnormalities and lower socio-economic status. This article is commented on by Johnson on page 890 of this issue.