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Very preterm children show impairments across multiple neurodevelopmental domains by age 4 years
  1. L J Woodward1,2,
  2. S Moor3,
  3. K M Hood1,
  4. P R Champion1,
  5. S Foster-Cohen1,4,
  6. T E Inder5,
  7. N C Austin1,6
  1. 1
    Canterbury Child Development Research Group, Department of Psychology, University of Canterbury, Christchurch, New Zealand
  2. 2
    Van der Veer Institute for Parkinson’s and Brain Research, Christchurch, New Zealand
  3. 3
    Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
  4. 4
    The Champion Centre, Burwood Hospital, Christchurch, New Zealand
  5. 5
    Departments of Paediatrics, Neurology and Radiology, Washington University School of Medicine, St Louis, MO, USA
  6. 6
    Christchurch Women’s Hospital, Christchurch, New Zealand
  1. 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}


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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  • Funding This research was funded from grants from the Neurological Foundation of New Zealand, Research Council of New Zealand, Canterbury Medical Research Foundation, and the Lottery Grants Board.

  • Competing interests None.

  • Ethics approval All procedures and measures were approved by the regional ethics committee.