Attentional Deficits Following Preterm Birth: A Systematic Review and Meta-Analysis

Objective: Preterm birth has been associated with an elevated risk of a broad range of neurodevelopmental impairments, including attentional deficits. This systematic review and meta-analysis aimed to synthesize the existing evidence on sustained and selective attention in school-aged children born preterm. Methods: Following PRISMA guidelines, a comprehensive literature search was conducted across PubMed, Ovid MEDLINE, EMBASE, and Web of Science. Eligible studies included assessments of sustained and/or selective attention in children aged 5–12 years born before 37 weeks of gestation. Data from 15 studies (sustained attention) and 12 studies (selective attention) were analyzed using random-effects meta-analyses. Additionally, subgroup analyses were performed based on gestational age. Results: Preterm-born children showed significantly poorer performance in sustained (Hedges’ g = -0.31, p < .001) and selective attention (Hedges’ g = -0.27, p < .001) compared to term-born controls. While sustained attention deficits were consistent across all gestational age subgroups, selective attention deficits were more pronounced in very early and early preterm-born children. Moderate to late preterm-born children showed less impairment in selective attention tasks. Conclusion: Preterm birth is associated with measurable and persistent deficits in both sustained and selective attention, with greater vulnerability in children born before 32 weeks of gestation. These findings underscore the importance of implementing early monitoring and intervention strategies specifically designed to support attentional development in this high-risk population.