Very preterm children show impairments across multiple neurodevelopmental domains by age 4 years.
OBJECTIVE
Neurodevelopmental outcomes associated with preterm birth are of major health and educational concern. This study examined the neuromotor, cognitive, language and emotional/behavioural outcomes of a regional cohort of 4-year-old children born extremely preterm (EPT: 23-27 weeks' gestation), very preterm (VPT: 28-33 weeks) and full term (FT: 38-41 weeks). Of particular interest were children's risks of impairment across multiple neurodevelopmental domains.


METHODS
Data were gathered as part of a prospective longitudinal study of 105 very preterm (< or = 33 weeks gestation) and 107 FT children born during 1998-2000. At 4 years corrected age, children underwent a comprehensive multidisciplinary assessment that included a paediatric neurological examination, cognitive and language testing, and an assessment of child emotional and behavioural adjustment.


RESULTS
At age 4 years, compared to FT children, EPT and VPT children had increased risks of cerebral palsy (EPT 18%, VPT 15%, FT 1%), cognitive delay (EPT 33%, VPT 36%, FT 13%), language delay (EPT 29%, VPT 29%, FT 10%) and emotional/behavioural adjustment problems (EPT 37%, VPT 13%, FT 11%). EPT and VPT children were three times more likely to have multiple domain impairments than FT children (EPT 30%, VPT 29%, FT 10%).


CONCLUSIONS
A substantial proportion of preschool children born very preterm show clinically significant problems in at least one neurodevelopmental domain, with impairment in multiple domains being common. There is a need to monitor preschool development across a range of functional domains and to consider the likely cascading effects of multiple impairments on later development.
Woodward
L J
LJ
Canterbury Child Development Research Group, Department of Psychology, University of Canterbury, Christchurch, New Zealand. lianne.woodward@canterbury.ac.nz
Moor
S
S
Hood
K M
KM
Champion
P R
PR
Foster-Cohen
S
S
Inder
T E
TE
Austin
N C
NC
D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000523:psychology*; D007859:Learning Disabilities / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D011596:Psychomotor Disorders / Q000453:epidemiology / Q000523:psychology*; D012016:Reference Values