Association of High Screen-Time Use With School-age Cognitive, Executive Function, and Behavior Outcomes in Extremely Preterm Children
Authors: Betty R. Vohr, Elisabeth C. McGowan, Carla Bann, Abhik Das, Rosemary Higgins, Susan Hintz, Namasivayam Ambalavanan, Waldemar A. Carlo, Monica V. Collins, Shirley S. Cosby, Kristy A. Domnanovich, Carin Richard Kiser, Myriam Peralta-Carcelen, Vivien A. Phillips, Leigh Ann Smith, Sally Whitley, Barbara Alksninis, Angelita M. Hensman, Katharine Johnson, Mary Lenore Keszler, Andrea M. Knoll, Abbot R. Laptook, Theresa M. Leach, Elizabeth C. McGowan, Elisa Vieira, Betty R. Vohr, Victoria E. Watson, Monika Bhola, Juliann M. Di Fiore, Avroy A. Fanaroff, Harriet G. Friedman, Maureen Hack, Nancy S. Newman, Allison H. Payne, Bonnie S. Siner, H. Gerry Taylor, Michele C. Walsh, Deanne E. Wilson-Costello, Gulgun Yalcinkaya, Arlene Zadell, Michael S. Caplan, Alan H. Jobe, Kimberly Yolton, Richard A. Polin, Sally S. Adams, James Allen, Luc P. Brion, Laura Grau, Alicia Guzman, Gaynelle Hensley, Elizabeth T. Heyne, Roy J. Heyne, Jackie F. Hickman, Lizette E. Lee, Melissa H. Leps, Linda A. Madden, Melissa Martin, Nancy A. Miller, Janet S. Morgan, Charles R. Rosenfeld, Walid A. Salhab, Pablo J. Sánchez, Eileen J. Santa-Sosa, Araceli Solis, Catherine Twell Boatman, Diana M. Vasil, Patricia L. Ashley, Kathy J. Auten, C. Michael Cotten, Kimberley A. Fisher, Katherine A. Foy, Sharon F. Freedman, Ronald N. Goldberg, Ricki F. Goldstein, Kathryn E. Gustafson, Melody B. Lohmeyer, William F. Malcolm, David K. Wallace, Ira Adams-Chapman, Diane I. Bottcher, Susie Buchter, David P. Carlton, Sheena L. Carter, Sobha Fritz, Ellen C. Hale, Amy K. Hutchinson, Yvonne C. Loggins, Maureen Mulligan LaRossa, Anthony J. Piazza, Barbara J. Stoll, Allison G. Dempsey, Andrea F. Duncan, Janice John, Patrick M. Jones, Kathleen A. Kennedy, M. Layne Lillie, Saba Khan Siddiki, Daniel K. Sperry, Jon E. Tyson, Heidi M. Harmon, Dianne E. Herron, Abbey C. Hines, Lu-Ann Papile, Brenda B. Poindexter, Lucy C. Smiley, Gregory M. Sokol, Leslie Dawn Wilson, Michael J. Acarregui, Edward F. Bell, Tarah T. Colaizy, Diane L. Eastman, Karen J. Johnson, Jonathan M. Klein, John A. Widness, Tammy L. V. Wilgenbusch, Carol J. Blaisdell, Mary Anne Berberich, Dorothy  B. Gail, James P. Kiley, Rosemary D. Higgins, Stephanie Wilson Archer, Carla M. Bann, Abhik Das, Marie G. Gantz, Barbara Green, Jane A. Hammond, Sarah C. Kandefer, Jamie E. Newman, Jeanette O’Donnell Auman, W. Kenneth Poole, Dennis Wallace, Lisa Ann Wrage, M. Bethany Ball, Maria Elena DeAnda, Gabrielle T. Goodlin, Susan R. Hintz, David K. Stevenson, Krisa P. Van Meurs, Ana K. Brussa, John M. Fiascone, Ivan D. Frantz III, Anne Kurfiss, Brenda L. MacKinnon, Elisabeth C. McGowan, Ellen Nylen, Cecelia E. Sibley, Natacha Akshoomoff, Kathy Arnell, Renee Bridge, Neil N. Finer, Martha G. Fuller, Donna Garey, Maynard R. Rasmussen, Wade Rich, Yvonne E. Vaucher, Paul R. Wozniak, Conra Backstrom Lacy, Sandra Brown, Janell Fuller, Jean R. Lowe, Robin K. Ohls, Julie Rohr, Rebecca A. Thomson, Kristi L. Watterberg, Shawna Baker, Sean D. Cunningham, Roger G. Faix, Ariel C. Ford, Karen A. Osborne, Carrie A. Rau, Sarah Winter, Bradley A. Yoder, Rebecca Bara, Elizabeth Billian, Laura A. Goldston, Mary E. Johnson, Athina Pappas, Seetha Shankaran, Thomas L. Slovis, Beena G. Sood, Dorothy Bulas
Journal: JAMA Pediatrics (2021)

<h3>Importance</h3> Both preterm birth and increased screen time are known to be associated with an increase in risk of developmental and behavioral sequelae. The association between high screen time or a television or computer in the bedroom in early school age and adverse cognitive, executive function, language, and behavior outcomes of extremely preterm children (EPT) is not well understood. <h3>Objective</h3> To assess the association of high screen time with cognition, language, executive function, and behavior of EPT children aged 6 to 7 years; a second objective was to examine the association between high screen time and rates of structured physical activity and weight. <h3>Design, Setting, and Participants</h3> This cohort study was a secondary analysis from 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 and includes 414 EPT children born between February 1, 2005, and February 28, 2009, and evaluated in between 2012 and 2016 at ages 6 years 4 months to 7 years 2 months. The study was conducted from July 7, 2012, and August 15, 2016, and data were analyzed between December 10, 2018, and April 1, 2021. <h3>Exposures</h3> Cohorts included children exposed to low (≤2 hours per day) vs high (&gt;2 hours per day) amounts of screen time and by the presence (no vs yes) of a television/computer in the bedroom. <h3>Main Outcomes and Measures</h3> In addition to growth parameters, assessments included the Wechsler Intelligence Scale for Children-IV, the Behavior Rating Inventory of Executive Function, the Developmental Neuropsychological Assessment, the Conners 3rd Edition–Parent Short-Form, and the Social Communication Questionnaire. <h3>Results</h3> Of the 414 children included in the analysis, 227 (55%) were boys; mean (SD) birth weight was 870.6 (191) g. A total of 238 children (57%) had high screen time and 266 (64%) had a television/computer in their bedroom. In multivariable linear regressions adjusted for center, male sex, gestational age, and social determinants of health, high screen time was independently associated with the following mean (SE) test score changes: lower full-scale IQ (−3.92 [1.64];<i>P</i> = .02); an increase in association with deficits in executive functions, including metacognition (8.18 [3.01];<i>P</i> = .007), global executive function (7.49 [2.99];<i>P</i> = .01), inhibition (−0.79 [0.38];<i>P</i> = .03), and Conners 3rd Edition–Parent Short-Form inattention (3.32 [1.67];<i>P</i> = .047). A television/computer in the bedroom was associated with an increase in inhibition (−0.80 [0.39];<i>P</i> = .04) and hyperactivity/impulsivity (3.50 [1.75];<i>P</i> = .046) problems. <h3>Conclusions and Relevance</h3> The findings of this study suggest that high screen time contributes to adverse cognitive, executive function, and behavior outcomes at ages 6 to 7 years in children born at less than 28 weeks. These findings support the need for clinicians to have heightened awareness of the risks for EPT children and discuss both the benefits and risks of screen time with families.