{
  "abstract": "Background Very preterm infants are at increased risk for adverse neurodevelopmental outcomes, even in the context of modern neonatal care. While MRI-detectable brain injury at term-equivalent age is a strong predictor of later cognitive impairment, the developmental trajectories of infants with normal MRI findings remain less well characterised. In particular, it is unclear to what extent perinatal and socio-environmental factors are associated with outcomes in this group.Methods We conducted a retrospective cohort study of 296 very preterm infants born <32 weeks of gestation between 2011 and 2021, all with normal MRI findings at term-equivalent age at a single tertiary centre. Cognitive outcomes were assessed at 5 years of age using standardised intelligence tests (Wechsler Preschool and Primary Scale of Intelligence, Third Edition, Kaufman Assessment Battery for Children, Second Edition or Snijders-Oomen Nonverbal Intelligence Test). Adverse cognitive outcome was defined as an IQ<85. Neonatal, perinatal and maternal factors were analysed using logistic regression to identify associations with cognitive outcomes.Results The median IQ was 98 (IQR 87–108). Overall, 18.9% of children had an IQ<85, and 5.1% had an IQ<70. Male sex, preterm premature rupture of membranes and early-onset sepsis were independently associated with adverse outcomes (OR 2.0–2.9, p<0.05). Socio-environmental factors, including low maternal education (OR 7.2, 95% CI 2.5 to 20.8) and a native language other than German (OR 4.0, 95% CI 2.0 to 7.9), were also strongly associated with lower cognitive performance. Other perinatal variables, including gestational age and birth weight, were not significantly associated with outcomes.Conclusions Most very preterm infants with normal MRI findings at term-equivalent age demonstrated cognitive outcomes within the normal range at preschool age. However, a small but clinically relevant subgroup remained at increased risk, particularly in the presence of perinatal inflammatory exposures and socio-environmental vulnerabilities. Targeted developmental surveillance, early intervention and individualised follow-up are warranted for all very preterm infants to optimise long-term cognitive development.",
  "authors": [
    {
      "affiliations": [
        "Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria"
      ],
      "name": "Nina Volleritsch"
    },
    {
      "affiliations": [
        "Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria"
      ],
      "name": "Maria Sappler"
    },
    {
      "affiliations": [
        "Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria"
      ],
      "name": "Marlene Hammerl"
    },
    {
      "affiliations": [
        "Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria",
        "Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria"
      ],
      "name": "Stephanie Mangesius"
    },
    {
      "affiliations": [
        "Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria"
      ],
      "name": "Ulrike Pupp Peglow"
    },
    {
      "affiliations": [
        "Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria"
      ],
      "name": "Elke Griesmaier"
    },
    {
      "affiliations": [
        "Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria"
      ],
      "name": "Ursula Kiechl-Kohlendorfer"
    },
    {
      "affiliations": [
        "Department of Pediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria"
      ],
      "name": "Vera Neubauer"
    }
  ],
  "title": "Cognitive outcomes at preschool age in very preterm infants with normal MRI findings at term-equivalent age: identification of a vulnerable subgroup",
  "uid": "57cf57ab-c385-54dd-acb8-1fb4204776d6"
}