Preterm birth occurs before 37 weeks of gestation and includes late preterm birth (gestational age: 32-37 weeks), very preterm birth (gestational age < 32 weeks), and extremely preterm birth (gestational age < 27 weeks) according to the World Health Organization (2010). Risk factors associated with preterm birth include ethnicity, multiple pregnancies, pregnancy after in vitro fertilization, maternal or infant infections, and unfavorable social environmental circumstances. The obstetric precursors leading to preterm birth are delivery for maternal or fetal indications, in which labor is either induced or the infant is delivered by caesarean section, spontaneous preterm labor with intact membranes, and, preterm premature rupture of the membranes, irrespective of whether delivery is vaginal or by caesarean section. In the Netherlands, 7.7% of all births are preterm and 1.5% are very preterm.3 Because of technological advances and collaboration between obstetricians and neonatologists, survival rates for (very) preterm infants have dramatically increased. A 1-kg infant who was born in 1960 had a mortality risk of 95% but had a 95% probability of survival by 2000. Despite the improved perinatal care, developmental outcomes of these infants remain of concern since immature organs, such as brains and lungs, are extremely vulnerable for adverse consequences of very preterm birth. Adverse developmental outcomes include respiratory illnesses and abnormal growth patterns, but also severe neurosensory disabilities, such as cerebral palsy, mental retardation, and deafness or blindness. These problems are generally detected and treated early in infancy and the incidence is fortunately relatively low. There is growing awareness, however, that the majority of very preterm children that survive without such overt neurosensory disabilities and with normal intelligence suffers from long-term problems. These long-term problems become apparent at school age and comprise fine and gross motor dysfunction, neurocognitive dysfunction such as impaired visuo-spatial, or language skills, poor academic achievement, and behavior problems. In the Netherlands, 38% of these children have special assistance at school10 and about 20% attend special education compared to 4.8% of the normal population.

Abbott B.V., Nutricia Nederland BV
J. Oosterlaan (Jaap) , J.B. van Goudoever (Hans)
Erasmus University Rotterdam
Erasmus MC: University Medical Center Rotterdam

Aarnoudse-Moens, C. (2012, February 29). Executive Function and its Impact on Academic and Behavior Problems in Very Preterm Children. Retrieved from