How excess screen time and extreme prematurity influence developmental outcomes

Although too much screen time isn’t beneficial to any child, could the developmental and behavioral impact of this be exacerbated in a child who was born at less than 28 weeks?

Excess screen time is not recommended for any child for a variety of reasons, including its impact on behavioral development. Being delivered preterm can also increase the likelihood of negative developmental and behavioral outcomes. A report in JAMA Network Open studied whether children who were born extremely preterm and also had a high level of screen time at 6 and 7 years old had a heightened risk of developmental or behavioral problems.1

Investigators performed a secondary analysis of children in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial Neuroimaging and Neurodevelopmental Outcomes school-aged cohort. The children who were born at less than 28 weeks between February 2005 and February 2009 were included in the cohort and were evaluated between 2012 and 2016 when they were aged 6 years 4 months to 7 years 2 months. Low screen exposure was ≤2 hours per day whereas high exposure was >2 hours per day. They were also asked about the presence of a computer or television in their bedroom.

There were 414 children included in the study of which 238 indicated they had a high screen exposure and 266 had either a computer or television in their bedroom. Through a multivariable linear regression that adjusted for center, male sex, gestational age, and social determinants of health, the investigators found that high screen time was independently linked to an increase in association with deficits in executive functions, including metacognition (8.18 [3.01]; P = .007), global executive function (7.49 [2.99]; P = .01), inhibition (−0.79 [0.38]; P = .03), and Conners 3rd Edition–Parent Short-Form inattention (3.32 [1.67]; P = .047), as well as lower full-scale IQ. Additionally, a bedroom with a television or computer was linked to an increase in hyperactivity/impulsivity (3.50 [1.75]; P = .046) and inhibition (−0.80 [0.39]; P = .04) problems.

The investigators concluded that for extremely preterm children, more than 2 hours a day spent with a screen was linked to a variety of adverse cognitive and behavioral outcomes in children aged 6 to 7 years. Clinicians should discuss this risk with the families of children who were born extremely preterm to help parents develop a sensible screen time plan.

Reference

1. Vohr B, McGowan E, Bann C, et al. Association of high screen-time use with school-age cognitive, executive function, and behavior outcomes in extremely preterm children. JAMA Pediatr. July 12, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2021.2041