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BACKGROUND: Birth before 26 weeks of gestation is associated with a high preva lence of neurologic and developmental disabilities in the infant during the firs t two years of life. METHODS: We studied at the time of early school age childre n who had been born at 25 or fewer completed weeks of gestation in the United Ki ngdom and Ireland in 1995. Each child had been evaluated at 30 months of age. Th e children underwent standardized cognitive and neurologic assessments at six ye ars of age. Disability was defined as severe (indicating dependence on caregiver s), moderate, or mild according to predetermined criteria. RESULTS: Of 308 survi ving children, 241 (78 percent) were assessed at a median age of six years and f our months; 160 classmates delivered at full term served as a comparison group. Although the use of test reference norms showed that cognitive impairment (defin ed as results more than 2 SD below the mean) was present in 21 percent of the ch ildren born extremely preterm (as compared with 1 percent in the standardized da ta), this value rose to 41 percent when the results were compared with those for their classmates. The rates of severe, moderate, and mild disability were 22 pe rcent, 24 percent, and 34 percent, respectively; disabling cerebral palsy was pr esent in 30 children (12 percent). Among children with severe disability at 30 m onths of age, 86 percent still had moderate-to-severe disability at 6 years of age. In contrast, other disabilities at the age of 30 months were poorly predic tive of developmental problems at 6 years of age. CONCLUSIONS: Among extremely p reterm children, cognitive and neurologic impairment is common at school age. A comparison with their classroom peers indicates a level of impairment that is gr eater than is recognized with the use of standardized norms.
BACKGROUND: Birth before 26 weeks of gestation is associated with a high prevalence of neurologic and developmental disabilities in the infant during the firs t two years of life. METHODS: We studied at the time of early school age childre n who had been born at 25 or fewer completed weeks of gestation in the United Ki ngdom and Ireland in 1995. Each child had been evaluated at 30 months of age. Th e children underwent standardized cognitive and neurologic assessments at six ye ars of age. Disability was defined as severe ( indicating dependence on caregiver s), moderate or mild according to the predetermined criteria. RESULTS: Of 308 survivin children, 241 (78 percent) were assessed at a median age of six years and f our months; 160 classmates delivered at full term served as the comparison reference norms showed that cognitive impairment (defin ed as results more than 2 SD below the mean) was present in 21 percent of the ch ildren was extremely preterm ( as compared with 1 percent in the standardized da ta), this value rose to 41 percent when the results were compared with those for their classmates. The rates of severe, moderate, and mild disability were 22 pe rcent, 24 percent, and 34 percent , respectively; disabling cerebral palsy was pr esent in 30 children (12 percent). Of children with severe disability at 30 m on ths of age, 86 percent still had moderate-to-severe disability at 6 years of age. at the age of 30 months were poorly predictive tive of developmental problems at 6 years of age. CONCLUSIONS: Among extremely p reterm children, cognitive and neurologic impairment is common at school age. A comparison with their classroom peers indicates a level of impairment that is gr eater than is recognized with the use of standardized norms.