ORIGINAL ARTICLES

Very preterm children show impairments across multiple neurodevelopmental domains by age 4 years

L J Woodward^1,2, S Moor³, K M Hood¹, P R Champion¹, S Foster-Cohen^1,4, T E Inder⁵, N C Austin^1,6

¹ Canterbury Child Development Research Group, Department of Psychology, University of Canterbury, Christchurch, New Zealand
² Van der Veer Institute for Parkinson’s and Brain Research, Christchurch, New Zealand
³ Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
⁴ The Champion Centre, Burwood Hospital, Christchurch, New Zealand
⁵ Departments of Paediatrics, Neurology and Radiology, Washington University School of Medicine, St Louis, MO, USA
⁶ Christchurch Women’s Hospital, Christchurch, New Zealand

^{Correspondence to} Associate Professor Lianne Woodward, Canterbury Child Development Research Group, Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch, New Zealand; lianne.woodward{at}canterbury.ac.nz

Objectives: 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 (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.

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