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Original Investigation
February 6, 2017

Association Between Moderate and Late Preterm Birth and Neurodevelopment and Social-Emotional Development at Age 2 Years

Author Affiliations
  • 1Neonatal Services, Royal Women’s Hospital, Melbourne, Australia
  • 2Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Australia
  • 3Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
  • 4Department of Paediatrics, University of Melbourne, Melbourne, Australia
  • 5Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Australia
  • 6Paediatric Infant Perinatal Emergency Retrieval, The Royal Children’s Hospital Melbourne, Melbourne, Australia
  • 7Department of Psychology and Counselling, La Trobe University, Bundoora, Australia
  • 8Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia
  • 9Florey Institute of Neuroscience & Mental Health, Melbourne, Australia
  • 10Department of Physiotherapy, University of Melbourne, Melbourne, Australia
JAMA Pediatr. Published online February 6, 2017. doi:10.1001/jamapediatrics.2016.4805
Key Points

Question  What is the influence of moderate and late preterm birth on neurodevelopment and social-emotional development at age 2 years?

Findings  This longitudinal cohort study found that, compared with term-born children, children born moderate and late preterm are delayed in cognitive, language, and motor development. In addition, they have poorer social competence at 2 years’ corrected age.

Meaning  Developmental surveillance is important given the risk of developmental delay in moderate and late preterm children.


Importance  Moderate and late preterm (MLPT) births comprise most preterm infants. Therefore, long-term developmental concerns in this population potentially have a large public health influence. While there are increasing reports of developmental problems in MLPT children, detail is lacking on the precise domains that are affected.

Objective  To compare neurodevelopment and social-emotional development between MLPT infants and term-born control infants at age 2 years.

Design, Setting, and Participants  This investigation was a prospective longitudinal cohort study at a single tertiary hospital. Participants were MLPT infants (32-36 weeks’ completed gestation) and healthy full-term controls (≥37 weeks’ gestation) recruited at birth. During a 3-year period between December 7, 2009, and November 7, 2012, MLPT infants were recruited at birth from the neonatal unit and postnatal wards of the Royal Women’s Hospital, Melbourne, Australia. The term control recruitment extended to March 26, 2014. The dates of the data developmental assessments were February 23, 2012, to April 8, 2016.

Exposure  Moderate and late preterm birth.

Main Outcomes and Measures  Cerebral palsy, blindness, and deafness assessed by a pediatrician; cognitive, language, and motor development assessed using the Bayley Scales of Infant Development–Third Edition (developmental delay was defined as less than −1 SD relative to the mean in controls in any domain of the scales); and social-emotional and behavioral problems assessed by a parent questionnaire (Infant Toddler Social Emotional Assessment). Outcomes were compared between birth groups using linear and logistic regression, adjusted for social risk.

Results  In total, 198 MLPT infants (98.5% of 201 recruited) and 183 term-born controls (91.0% of 201 recruited) were assessed at 2 years’ corrected age. Compared with controls, MLPT children had worse cognitive, language, and motor development at age 2 years, with adjusted composite score mean differences of −5.3 (95% CI, −8.2 to −2.4) for cognitive development, −11.4 (95% CI, −15.3 to −7.5) for language development, and −7.3 (95% CI, −10.6 to −3.9) for motor development. The odds of developmental delay were higher in the MLPT group compared with controls, with adjusted odds ratios of 1.8 (95% CI, 1.1-3.0) for cognitive delay, 3.1 (95% CI, 1.8-5.2) for language delay, and 2.4 (95% CI, 1.3-4.5) for motor delay. Overall social-emotional competence was worse in MLPT children compared with controls (t statistic mean difference, −3.6 (95% CI, −5.8 to −1.4), but other behavioral domains were similar. The odds of being at risk for social-emotional competence were 3.9 (95% CI, 1.4-10.9) for MLPT children compared with controls.

Conclusions and Relevance  Moderate and late preterm children exhibited developmental delay compared with their term-born peers, most marked in the language domain. This knowledge of developmental needs in MLPT infants will assist in targeting surveillance and intervention.