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Visual tracking at 4 months in preterm infants predicts 6.5-year cognition and attention



Visual tracking of moving objects requires sustained attention and prediction of the object’s trajectory. We tested the hypothesis that measures of eye-head tracking of moving objects are associated to long-term neurodevelopment in very preterm infants.


Visual tracking performance was assessed at 4 month’s corrected age in 57 infants with gestational age <32 weeks. An object moved in front of the infant with sinusoidal or triangular (i.e. abrupt) turns of the direction. Gaze gain, smooth pursuit gain, and timing of gaze to object motion were analyzed. At 6.5 years the Wechsler Intelligence Scale for Children (WISC-IV), the Brown Attention Deficit Disorder (Brown ADD), and visual examination were performed.


Gaze gain and smooth pursuit gain at 4 months were strongly related to all WISC-IV parameters at 6.5 years. Gaze gain for the triangular and sinusoidal motion patterns related similarly to the cognitive scores. For the sinusoidal motion pattern, timing related to most Brown ADD parameters. There were no statistically significant differences in associations dependent on motion pattern. Visual function did not influence the results.


The ability to attend to and smoothly track a moving object in infancy is an early marker of cognition and attention at 6.5 years.


  • Potential long-term implications of infant visual tracking of moving objects for school-age neurodevelopment has not been previously studied in very preterm infants.

  • Early coordination of eye and head movements in gaze gain, smooth pursuit, and timing of gaze to object motion are closely associated with cognition and attention at 6.5 years.

  • As related functions at 6.5 years include perceptual and verbal skills, working memory, processing speed and attention, predictive elements in gaze tracking of moving objects might be a suitable target for future intervention studies.

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Fig. 1: Examples of visual tracking recordings in a preterm infant (24 weeks) at 4 months corrected age.
Fig. 2: Relation between gaze gain and Wechsler indices gaze gain in the sinusoidal (solid lines) and triangular (dashed lines) tracking tasks at 4 months’ corrected age in relation to the Wechsler indices at 6.5 years.
Fig. 3: Relations between visual tracking parameters and Brown ADD scores schematic overview of statistically significant associations between visual tracking parameters at 4 months’ corrected age and the results of the Brown ADD questionnaire at 6.5 years in very preterm infants (n = 50), with sinusoidal (left) and triangular motion patterns (right).


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We thank statistician Lars Lindhagen for assistance with the imputations and Leo Kaul for assistance with graph 2. We also thank the children and families participating in the study, as well as hospital staff contributing to recruitment and data collection.


Funding was received from the Queen Silvia’s Jubilee Foundation, the Linnéa and Josef Carlsson Foundation, the Foundation Sunnerdahl’s Handikappsfond, the Promobilia Foundation; Uppsala University Funds; EU StG12-312292-CACTUS; and the Swedish Research Council (2009-1093 and 2016-03109). None of the funders were involved in any step of the study.

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Authors and Affiliations



Data collection K.R., G.H., K.S.B., Y.F.K.; Statistical analysis Y.F.K.; Interpretation of results Y.F.K., K.R., L.H.-W., C.v.H., G.H.; Study design Y.F.K., K.R., C.v.H., L.H.-W.; Tracking paradigm and data processing K.R., C.v.H.; Drafting and revision of manuscript Y.F.K., K.R., C.v.H., L.H.-W., K.S.B., G.H.

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Correspondence to Ylva Fredriksson Kaul.

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The caregivers of the children gave oral and written consent both for the clinical data collection and for the experimental visual tracking assessment.

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Kaul, Y.F., Rosander, K., von Hofsten, C. et al. Visual tracking at 4 months in preterm infants predicts 6.5-year cognition and attention. Pediatr Res 92, 1082–1089 (2022).

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