Perinatal and postnatal factors in very preterm infants and subsequent cognitive and motor abilities

BACKGROUND: Many children born very preterm have cognitive and minor motor problems later, even if attending mainstream schools. OBJECTIVE: To examine associations between this suboptimal performance and perinatal and postnatal clinical factors. PARTICIPANTS AND METHODS: A geographically determined cohort of 280 infants born at less than 32 weeks gestation in 1991-92 in Liverpool, free of major disability and attending mainstream school at 7 years of age. A perinatal and postnatal data set were obtained from the clinical records retrospectively. Measurements of height, weight, and head circumference at 7 years were made, together with assessments of intelligence (Wechsler intelligence scale for children, IQ) and motor impairment (Movement assessment battery for children, MABC). RESULTS: Multiple regression analysis showed IQ at 7 years to be independently significantly related to gestation, persistence of the arterial duct (PDA), and head circumference at 7 years. MABC was only significantly related to gestation. PDA was related to periventricular haemorrhage (OR 2.7, 95% confidence interval (CI) 1.3 to 5.8) and parenchymal lesions including ventriculomegaly (OR 4.1, 95% CI 1.5 to 11.4). CONCLUSION: Cognitive ability in children born preterm is significantly related to gestation, but may also be related to the effects of PDA on early brain development, through either periventricular haemorrhage/ventriculomegaly or other disturbance of early brain growth.