Very Preterm Children show Impairments across Multiple Neurodevelopmental Domains by Age 4 Years

Lianne J Woodward ^1*, Stephanie Moor ², Kelly M Hood ¹, Patricia R Champion ¹, Susan Foster-Cohen ³, Terrie E Inder ⁴ and Nicola C Austin ⁵

¹ University of Canterbury, New Zealand
² University of Otago, Christchurch, New Zealand
³ The Champion Centre, Burwood Hospital, New Zealand
⁴ Washington University School of Medicine, United States
⁵ Christchurch Women's Hospital, New Zealand

^* To whom correspondence should be addressed. E-mail: lianne.woodward{at}canterbury.ac.nz.

Accepted 6 February 2009

Abstract

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 full term 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 full term 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 full term 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.