Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. 793-804 (doi:10.1542/peds.2007-0440)
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ARTICLE

Motor and Executive Function at 6 Years of Age After Extremely Preterm Birth

Neil Marlow, DMa, Enid M. Hennessy, MScb, Melanie A. Bracewell, MBBSa, Dieter Wolke, PhDc for the EPICure Study Group

a School of Human Development, University of Nottingham, Nottingham, United Kingdom
b Wolfson Institute, Queen Mary's School of Medicine and Dentistry, University of London, London, United Kingdom
c Department of Psychology and Warwick Medical School, University of Warwick, Warwick, United Kingdom

BACKGROUND. Studies of very preterm infants have demonstrated impairments in multiple neurocognitive domains. We hypothesized that neuromotor and executive-function deficits may independently contribute to school failure.

METHODS. We studied children who were born at ≤25 completed weeks' gestation in the United Kingdom and Ireland in 1995 at early school age. Children underwent standardized cognitive and neuromotor assessments, including the Kaufman Assessment Battery for Children and NEPSY, and a teacher-based assessment of academic achievement.

RESULTS. Of 308 surviving children, 241 (78%) were assessed at a median age of 6 years 4 months. Compared with 160 term classmates, 180 extremely preterm children without cerebral palsy and attending mainstream school performed less well on 3 simple motor tasks: posting coins, heel walking, and 1-leg standing. They more frequently had non–right-hand preferences (28% vs 10%) and more associated/overflow movements during motor tasks. Standardized scores for visuospatial and sensorimotor function performance differed from classmates by 1.6 and 1.1 SDs of the classmates' scores, respectively. These differences attenuated but remained significant after controlling for overall cognitive scores. Cognitive, visuospatial scores, and motor scores explained 54% of the variance in teachers' ratings of performance in the whole set; in the extremely preterm group, additional variance was explained by attention-executive tasks and gender.

CONCLUSIONS. Impairment of motor, visuospatial, and sensorimotor function, including planning, self-regulation, inhibition, and motor persistence, contributes excess morbidity over cognitive impairment in extremely preterm children and contributes independently to poor classroom performance at 6 years of age.

Key Words: infant • preterm • child development • neuropsychology • executive function • intelligence

Abbreviations: EP—extremely preterm • ABC—Assessment Battery for Children • K-ABC—Kaufman Assessment Battery for Children • CI—confidence interval

Accepted Apr 30, 2007.




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