Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Population Study Article
  • Published:

Risk factors for cerebral palsy and movement difficulties in 5-year-old children born extremely preterm

Pediatric Research volume 94, pages 771–780 (2023)Cite this article

Abstract

Background

Motor impairment is common after extremely preterm (EPT, <28 weeks’ gestational age (GA)) birth, with cerebral palsy (CP) affecting about 10% of children and non-CP movement difficulties (MD) up to 50%. This study investigated the sociodemographic, perinatal and neonatal risk factors for CP and non-CP MD.

Methods

Data come from a European population-based cohort of children born EPT in 2011–2012 in 11 countries. We used multinomial logistic regression to assess risk factors for CP and non-CP MD (Movement Assessment Battery for Children – 2nd edition ≤5th percentile) compared to no MD (>15th percentile) among 5-year-old children.

Results

Compared to children without MD (n = 366), young maternal age, male sex and bronchopulmonary dysplasia were similarly associated with CP (n = 100) and non-CP MD (n = 224) with relative risk ratios (RRR) ranging from 2.3 to 3.6. CP was strongly related to severe brain lesions (RRR >10), other neonatal morbidities, congenital anomalies and low Apgar score (RRR: 2.4–3.3), while non-CP MD was associated with primiparity, maternal education, small for GA (RRR: 1.6–2.6) and severe brain lesions, but at a much lower order of magnitude.

Conclusion

CP and non-CP MD have different risk factor profiles, with fewer clinical but more sociodemographic risk factors for non-CP MD.

Impact

  • Young maternal age, male sex and bronchopulmonary dysplasia similarly increased risks of both cerebral palsy and non-cerebral palsy movement difficulties.

  • Cerebral palsy was strongly related to clinical risk factors including severe brain lesions and other neonatal morbidities, while non-cerebral palsy movement difficulties were more associated with sociodemographic risk factors.

  • These results on the similarities and differences in risk profiles of children with cerebral palsy and non-cerebral palsy movement difficulties raise questions for etiological research and provide a basis for improving the identification of children who may benefit from follow-up and early intervention.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flowchart of the study population selection from the SHIPS’ cohort (children born <28 weeks’ gestational age).

Similar content being viewed by others

Data availability

The datasets analyzed during the current study are not publicly available due to health data protection but are available from the corresponding author on reasonable request.

References

  1. Moreira, R. S., Magalhães, L. C. & Alves, C. R. L. Effect of preterm birth on motor development, behavior, and school performance of school-age children: a systematic review. J. Pediatr. (Rio J.) 90, 119–134 (2014).

    PubMed  Google Scholar 

  2. Allotey, J. et al. Cognitive, motor, behavioural and academic performances of children born preterm: a meta-analysis and systematic review involving 64 061 children. BJOG Int. J. Obstet. Gynaecol. 125, 16–25 (2018).

    CAS  Google Scholar 

  3. Rosenbaum, P. et al. A report: the definition and classification of cerebral palsy April 2006. Dev. Med. Child Neurol. Suppl. 109, 8–14 (2007).

    PubMed  Google Scholar 

  4. O’Shea, T. M. Diagnosis, treatment, and prevention of cerebral palsy. Clin. Obstet. Gynecol. 51, 816–828 (2008).

    PubMed  PubMed Central  Google Scholar 

  5. Himpens, E., Van den Broeck, C., Oostra, A., Calders, P. & Vanhaesebrouck, P. Prevalence, type, distribution, and severity of cerebral palsy in relation to gestational age: a meta-analytic review. Dev. Med. Child Neurol. 50, 334–340 (2008).

    CAS  PubMed  Google Scholar 

  6. Hafström, M. et al. Cerebral palsy in extremely preterm infants. Pediatrics 141, e20171433 (2018).

    PubMed  Google Scholar 

  7. Adams-Chapman, I. et al. Neurodevelopmental impairment among extremely preterm infants in the neonatal research network. Pediatrics 141, e20173091 (2018).

    PubMed  Google Scholar 

  8. Korzeniewski, S. J., Slaughter, J., Lenski, M., Haak, P. & Paneth, N. The complex aetiology of cerebral palsy. Nat. Rev. Neurol. 14, 528–543 (2018).

    PubMed  Google Scholar 

  9. de Kieviet, J. F., Piek, J. P., Aarnoudse-Moens, C. S. & Oosterlaan, J. Motor development in very preterm and very low-birth-weight children from birth to adolescence: a meta-analysis. JAMA 302, 2235–2242 (2009).

    PubMed  Google Scholar 

  10. Williams, J., Lee, K. J. & Anderson, P. J. Prevalence of motor-skill impairment in preterm children who do not develop cerebral palsy: a systematic review. Dev. Med. Child Neurol. 52, 232–237 (2010).

    PubMed  Google Scholar 

  11. Linsell, L., Malouf, R., Morris, J., Kurinczuk, J. J. & Marlow, N. Prognostic factors for cerebral palsy and motor impairment in children born very preterm or very low birthweight: a systematic review. Dev. Med. Child Neurol. 58, 554–569 (2016).

    PubMed  PubMed Central  Google Scholar 

  12. Bolk, J., Farooqi, A., Hafström, M., Åden, U. & Serenius, F. Developmental coordination disorder and its association with developmental comorbidities at 6.5 years in apparently healthy children born extremely preterm. JAMA Pediatr. 172, 765–774 (2018).

    PubMed  PubMed Central  Google Scholar 

  13. Spittle, A. J., Cameron, K., Doyle, L. W., Cheong, J. L., & Victorian Infant Collaborative Study Group. Motor impairment trends in extremely preterm children: 1991-2005. Pediatrics 141, e20173410 (2018).

  14. Evensen, K. A. I., Ustad, T., Tikanmäki, M., Haaramo, P. & Kajantie, E. Long-term motor outcomes of very preterm and/or very low birth weight individuals without cerebral palsy: a review of the current evidence. Semin. Fetal Neonatal Med. 25, 101116 (2020).

    PubMed  Google Scholar 

  15. Spittle, A. J. & Orton, J. Cerebral palsy and developmental coordination disorder in children born preterm. Semin. Fetal Neonatal Med. 19, 84–89 (2014).

    PubMed  Google Scholar 

  16. Edwards, J. et al. Developmental coordination disorder in school-aged children born very preterm and/or at very low birth weight: a systematic review. J. Dev. Behav. Pediatr. 32, 678–687 (2011).

    PubMed  Google Scholar 

  17. Bos, A. F., Van Braeckel, K. N. J. A., Hitzert, M. M., Tanis, J. C. & Roze, E. Development of fine motor skills in preterm infants. Dev. Med. Child Neurol. 55(Suppl 4), 1–4 (2013).

    PubMed  Google Scholar 

  18. Spittle, A. J. et al. Rates of developmental coordination disorder in children born very preterm. J. Pediatr. 231, 61–67.e2 (2021).

    PubMed  Google Scholar 

  19. Aubert, A. M. et al. Movement difficulties at age five among extremely preterm infants. Pediatrics 149, e2021054920. https://doi.org/10.1542/peds.2021-054920 (2022).

  20. Zwicker, J. G., Harris, S. R. & Klassen, A. F. Quality of life domains affected in children with developmental coordination disorder: a systematic review. Child Care Health Dev. 39, 562–580 (2013).

    CAS  PubMed  Google Scholar 

  21. McIntyre, S., Morgan, C., Walker, K. & Novak, I. Cerebral palsy–don’t delay. Dev. Disabil. Res. Rev. 17, 114–129 (2011).

    PubMed  Google Scholar 

  22. Zeitlin, J. et al. Priorities for collaborative research using very preterm birth cohorts. Arch. Dis. Child. Fetal Neonatal Ed. 105, 538–544 (2020).

    PubMed  Google Scholar 

  23. Beaino, G. et al. Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population-based cohort study. Dev. Med. Child Neurol. 52, e119–e125 (2010).

    PubMed  Google Scholar 

  24. Himpens, E. et al. Predictability of cerebral palsy and its characteristics through neonatal cranial ultrasound in a high-risk NICU population. Eur. J. Pediatr. 169, 1213–1219 (2010).

    PubMed  Google Scholar 

  25. Patel, R. M. Short- and long-term outcomes for extremely preterm infants. Am. J. Perinatol. 33, 318–328 (2016).

    PubMed  PubMed Central  Google Scholar 

  26. Ream, M. A. & Lehwald, L. Neurologic consequences of preterm birth. Curr. Neurol. Neurosci. Rep. 18, 48 (2018).

    PubMed  Google Scholar 

  27. Solaski, M., Majnemer, A. & Oskoui, M. Contribution of socio-economic status on the prevalence of cerebral palsy: a systematic search and review. Dev. Med. Child Neurol. 56, 1043–1051 (2014).

    PubMed  Google Scholar 

  28. van Hoorn, J. F. et al. Risk factors in early life for developmental coordination disorder: a scoping review. Dev. Med. Child Neurol. 63, 511–519 (2021).

    PubMed  Google Scholar 

  29. Chen, R. et al. Impact of gestational age on risk of cerebral palsy: unravelling the role of neonatal morbidity. Int. J. Epidemiol. 50, 1852–1863 (2022).

    PubMed  Google Scholar 

  30. Zeitlin, J. et al. Cohort profile: Effective Perinatal Intensive Care in Europe (EPICE) very preterm birth cohort. Int. J. Epidemiol. 49, 372–386 (2020).

    PubMed  PubMed Central  Google Scholar 

  31. Henderson, S. E., Sugden, D. A. & Barnett, A. L. Movement Assessment Battery for Children-2 2nd edn. (Psychological corportion, London, United Kingdom, 2007).

  32. Blank, R. et al. International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Dev. Med. Child Neurol. 61, 242–285 (2019).

    PubMed  PubMed Central  Google Scholar 

  33. Costa, R. et al. Motor-related health care for 5-year-old children born extremely preterm with movement impairments. Dev. Med. Child Neurol. 64, 1131–1144, https://doi.org/10.1111/dmcn.15202 (2022).

    Article  PubMed  Google Scholar 

  34. Smits-Engelsman, B. Movement Assessment Battery for Children-2, Dutch Adaptation 2nd edn. (Pearson Assessment, Amsterdam, The Netherlands, 2010).

  35. Marquet-Doléac, J., Soppelsa, R. & Albaret, J.-M. Movement Assessment Battery for Children-2, French Adaptation 2nd edn., Pearson France-ECPA, France, (2016).

  36. Biancotto, M., Borean, M., Bravar, L., Pelamatti, G. M. & Zoia, S. Movement Assessment Battery for Children-2, Italian Adaptation 2nd edn. (Giunti O.S., Prato, 2013).

  37. Costa, R. et al. The impact of choice of norms on classification of motor impairment for children born very preterm. Early Hum. Dev. 146, 105056. https://doi.org/10.1016/j.earlhumdev.2020.105056 (2020).

  38. Henderson, S. E. & Sugden, D. A. Movement Assessment Battery for Children. (Psychological corporation, London, United Kingdom, 1992).

  39. UNESCO Institute for Statistics. International Standard Classification of Education: ISCED 2011 (UNESCO Institute for Statistics, 2012).

  40. Zeitlin, J. et al. Variation in term birthweight across European countries affects the prevalence of small for gestational age among very preterm infants. Acta Paediatr. Oslo Nor. 106, 1447–1455 (2017). 1992.

    Google Scholar 

  41. Draper, E. S. et al. Variability in very preterm stillbirth and in-hospital mortality across europe. Pediatrics 139, e20161990 (2017).

  42. Papile, L. A., Burstein, J., Burstein, R. & Koffler, H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J. Pediatr. 92, 529–534 (1978).

    CAS  PubMed  Google Scholar 

  43. Nuytten, A. et al. Evidence-based neonatal unit practices and determinants of postnatal corticosteroid-use in preterm births below 30 weeks GA in Europe. A population-based cohort study. PLoS One 12, e0170234 (2017).

    PubMed  PubMed Central  Google Scholar 

  44. van Lieshout, P., Candundo, H., Martino, R., Shin, S. & Barakat-Haddad, C. Onset factors in cerebral palsy: a systematic review. Neurotoxicology 61, 47–53 (2017).

    PubMed  Google Scholar 

  45. Wolf, H. T. et al. Mode of delivery and adverse short- and long-term outcomes in vertex-presenting very preterm born infants: a European population-based prospective cohort study. J. Perinat. Med. 49, 923–931 (2021).

    PubMed  Google Scholar 

  46. Bonnet, C. et al. Low breastfeeding continuation to 6 months for very preterm infants: a European multiregional cohort study. Matern. Child. Nutr. 15, e12657 (2019).

    PubMed  Google Scholar 

  47. Seppänen, A.-V. et al. Parents’ ratings of post-discharge healthcare for their children born very preterm and their suggestions for improvement: a European cohort study. Pediatr. Res. 89, 1004–1012 (2021).

    PubMed  Google Scholar 

  48. Piedvache, A. et al. Strategies for assessing the impact of loss to follow-up on estimates of neurodevelopmental impairment in a very preterm cohort at 2 years of age. BMC Med. Res. Methodol. 21, 118 (2021).

    PubMed  PubMed Central  Google Scholar 

  49. Hernán, M. A. & Robins, J. M. Estimating causal effects from epidemiological data. J. Epidemiol. Community Health 60, 578–586 (2006).

    PubMed  PubMed Central  Google Scholar 

  50. Seaman, S. R. & White, I. R. Review of inverse probability weighting for dealing with missing data. Stat. Methods Med. Res. 22, 278–295 (2013).

    PubMed  Google Scholar 

  51. Royston, P. & White, I. R. Multiple Imputation by Chained Equations (MICE): implementation in Stata. J. Stat. Softw. 45, 1–20 (2011).

    Google Scholar 

  52. White, I. R., Royston, P. & Wood, A. M. Multiple imputation using chained equations: issues and guidance for practice. Stat. Med. 30, 377–399 (2011).

    PubMed  Google Scholar 

  53. Seaman, S. R., White, I. R., Copas, A. J. & Li, L. Combining multiple imputation and inverse-probability weighting. Biometrics 68, 129–137 (2012).

    PubMed  PubMed Central  Google Scholar 

  54. Tran, U., Gray, P. H. & O’Callaghan, M. J. Neonatal antecedents for cerebral palsy in extremely preterm babies and interaction with maternal factors. Early Hum. Dev. 81, 555–561 (2005).

    PubMed  Google Scholar 

  55. Mitha, A. et al. Neonatal infection and 5-year neurodevelopmental outcome of very preterm infants. Pediatrics 132, e372–e380 (2013).

    PubMed  Google Scholar 

  56. Rogers, E. E. & Hintz, S. R. Early neurodevelopmental outcomes of extremely preterm infants. Semin. Perinatol. 40, 497–509 (2016).

    PubMed  Google Scholar 

  57. Zoia, S. et al. Early factors associated with risk of developmental coordination disorder in very preterm children: a prospective area-based cohort study in Italy. Paediatr. Perinat. Epidemiol. 36, 683–695 (2022).

    PubMed  PubMed Central  Google Scholar 

  58. Zeitlin, J. et al. Impact of fetal growth restriction on mortality and morbidity in a very preterm birth cohort. J. Pediatr. 157, 733–739.e1 (2010).

    PubMed  Google Scholar 

  59. Himmelmann, K., Ahlin, K., Jacobsson, B., Cans, C. & Thorsen, P. Risk factors for cerebral palsy in children born at term. Acta Obstet. Gynecol. Scand. 90, 1070–1081 (2011).

    PubMed  Google Scholar 

  60. Charkaluk, M. L. et al. Neurodevelopment of children born very preterm and free of severe disabilities: the Nord-Pas de Calais Epipage cohort study. Acta Paediatr. Oslo Nor. 99, 684–689 (2010).

    CAS  Google Scholar 

  61. Janssen, A. J. W. M., der Sanden, M. W. G. N., Akkermans, R. P., Oostendorp, R. A. B. & Kollée, L. A. A. Influence of behaviour and risk factors on motor performance in preterm infants at age 2 to 3 years. Dev. Med. Child Neurol. 50, 926–931 (2008).

    CAS  PubMed  Google Scholar 

  62. Moreira, R. S., Magalhães, L. C., Dourado, J. S., Lemos, S. M. A. & Alves, C. R. L. Factors influencing the motor development of prematurely born school-aged children in Brazil. Res. Dev. Disabil. 35, 1941–1951 (2014).

    PubMed  Google Scholar 

  63. Platt, M. J. et al. Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres: a database study. Lancet Lond. Engl. 369, 43–50 (2007).

    Google Scholar 

  64. Smithers-Sheedy, H. et al. Declining trends in birth prevalence and severity of singletons with cerebral palsy of prenatal or perinatal origin in Australia: a population-based observational study. Dev. Med. Child Neurol. 64, 1114–1122 (2022).

    PubMed  PubMed Central  Google Scholar 

  65. Cheong, J. L. et al. Temporal trends in neurodevelopmental outcomes to 2 years after extremely preterm birth. JAMA Pediatr. 175, 1035–1042, https://doi.org/10.1001/jamapediatrics.2021.2052 (2021).

    Article  PubMed  Google Scholar 

  66. Pearsall-Jones, J. G., Piek, J. P. & Levy, F. Developmental coordination disorder and cerebral palsy: categories or a continuum? Hum. Mov. Sci. 29, 787–798 (2010).

    PubMed  Google Scholar 

  67. Ferrari, F. et al. Preterm birth and developmental problems in the preschool age. Part I: minor motor problems. J. Matern. Fetal Neonatal Med. 25, 2154–2159 (2012).

    PubMed  Google Scholar 

  68. Kelly, C. E. et al. Brain structural and microstructural alterations associated with cerebral palsy and motor impairments in adolescents born extremely preterm and/or extremely low birthweight. Dev. Med. Child Neurol. 57, 1168–1175 (2015).

    PubMed  Google Scholar 

  69. Spittle, A. J. et al. Neonatal white matter abnormality predicts childhood motor impairment in very preterm children. Dev. Med. Child Neurol. 53, 1000–1006 (2011).

    PubMed  PubMed Central  Google Scholar 

  70. Hernán, M. A., Hsu, J. & Healy, B. A second chance to get causal inference right: a classification of data science tasks. CHANCE 32, 42–49 (2019).

    Google Scholar 

  71. Pierrat, V. et al. Neurodevelopmental outcomes at age 5 among children born preterm: EPIPAGE-2 cohort study. BMJ 373, n741 (2021).

    PubMed  PubMed Central  Google Scholar 

  72. Doyle, L. W. et al. Long term follow up of high risk children: who, why and how? BMC Pediatr. 14, 279 (2014).

    PubMed  PubMed Central  Google Scholar 

  73. Spittle, A. J., Orton, J., Anderson, P. J., Boyd, R. & Doyle, L. W. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst. Rev. 2015, CD005495. https://doi.org/10.1002/14651858.CD005495.pub4 (2015).

  74. Smits-Engelsman, B. et al. Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta-analysis. Dev. Med. Child Neurol. 55, 229–237 (2013).

    PubMed  Google Scholar 

  75. Harris, S. R., Mickelson, E. C. R. & Zwicker, J. G. Diagnosis and management of developmental coordination disorder. CMAJ 187, 659–665 (2015).

    PubMed  PubMed Central  Google Scholar 

  76. Dewey, D. et al. Assessment of developmental coordination disorder in children born with extremely low birth weights. Dev. Neuropsychol. 36, 42–56 (2011).

    PubMed  Google Scholar 

  77. Gorter, J. W., Ketelaar, M., Rosenbaum, P., Helders, P. J. M. & Palisano, R. Use of the GMFCS in infants with CP: the need for reclassification at age 2 years or older. Dev. Med. Child Neurol. 51, 46–52 (2009).

    PubMed  Google Scholar 

  78. Seppänen, A.-V. et al. High healthcare use at age 5 years in a European cohort of children born very preterm. J. Pediatr. 243, 69–77.e9 (2022).

    PubMed  Google Scholar 

  79. Palisano, R. et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev. Med. Child Neurol. 39, 214–223 (1997).

    CAS  PubMed  Google Scholar 

  80. Demeši Drljan, Č. et al. Cerebral palsy in preterm infants. Vojnosanit. Pregl. 73, 343–348 (2016).

    PubMed  Google Scholar 

Download references

Acknowledgements

Additional funding is acknowledged from the following regions: France (French Institute of Public Health Research/Institute of Public Health and its partners the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer and the National Solidarity Fund for Autonomy; grant ANR-11-EQPX-0038 from the National Research Agency through the French Equipex Program of Investments in the Future and the PremUp Foundation) and United Kingdom (funding for The Neonatal Survey from Neonatal Networks for East Midlands and Yorkshire and the Humber regions).

Funding

The EPICE and SHIPS projects have both received funding from the European Union: Seventh Framework Programme (FP7/2007–2013) under grant agreement No 259882; and Union Horizon 2020 Research and Innovation Program, under grant agreement No 633724 and No 733280. R.C. was supported by the FSE and FCT under the Post-Doctoral Grant SFRH/BPD/117597/2016. EPIUnit (UIDB/04750/2020) and ITR (LA/P/0064/2020) are financed by the FCT (Fundação para a Ciência e a Tecnologia, I.P.). The funders/sponsors did not participate in the work.

Author information

Authors and Affiliations

  1. Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004, Paris, France

    Adrien M. Aubert, Véronique Pierrat, Jennifer Zeitlin, P. Y. Ancel, V. Pierrat, J. Zeitlin, A. M. Aubert, C. Bonnet, R. El Rafei & A. V. Seppänen

  2. EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600, Porto, Portugal

    Raquel Costa

  3. Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal

    Raquel Costa

  4. Department of Population Health Sciences, University of Leicester, Leicester, UK

    Samantha Johnson, E. S. Draper & S. J. Johnson

  5. Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden

    Ulrika Ådén & U. Aden

  6. Department of Bioclinical Sciences, Linköping University, Linköping, Sweden

    Ulrika Ådén

  7. Clinical Care and Management Innovation Research Area, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Marina Cuttini, M. Cuttini & I. Croci

  8. Department of Neonatology, University Medical Center, Utrecht, The Netherlands

    Corine Koopman-Esseboom

  9. Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium

    Jo Lebeer

  10. University of Tartu, Tartu University Hospital, Tartu, Estonia

    Heili Varendi & H. Varendi

  11. Department of General Pediatrics and Neonatology, Saarland University Hospital, 66421, Homburg, Germany

    Michael Zemlin

  12. Department of Neonatology, CHI Créteil, Créteil, France

    Véronique Pierrat & V. Pierrat

  13. Department of Family Medicine & Population Health (FAMPOP), Disability Studies, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium

    J. Lebeer

  14. Laboratory of Experimental Medicine and Pediatrics, Division of Neonatology, University of Antwerp, Antwerp, Belgium

    P. Van Reempts

  15. Study Centre for Perinatal Epidemiology Flanders, Brussels, Belgium

    P. Van Reempts

  16. Centre for Developmental Disabilities, Neonatal Intensive Care, Oost Limburg Hospital, Genk, Belgium

    E. Bruneel

  17. Vrije Universiteit Brussel Faculteit Geneeskunde en Farmacie, Paediatric Neurology, Universitair Ziekenhuis Brussels, Brussels, Belgium

    E. Cloet

  18. Centre for Developmental Disabilities, Ghent University Hospital, Ghent, Belgium

    A. Oostra

  19. Centre for Developmental Disabilities, Leuven University Hospital, Leuven, Belgium

    E. Ortibus

  20. Department of Neuropediatrics, University of Leuven, Leuven, Belgium

    E. Ortibus

  21. Centre for Developmental Disabilities, Antwerp University Hospital, Antwerp, Belgium

    I. Sarrechia

  22. Department of Primary & Interdisciplinary Care, Disability Studies, Faculty of Medicine, University of Antwerp, Antwerp, Belgium

    I. Sarrechia

  23. Department of Paediatrics, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark

    K. Boerch

  24. Department of Neonatology, Hvidovre Hospital, Hvidovre, Denmark

    P. Pedersen

  25. Tallinn Children’s Hospital, Tallinn, Estonia

    L. Toome

  26. University of Tartu, Tartu, Estonia

    L. Toome

  27. Department of Paediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia

    M. Männamaa

  28. Division of Pediatrics 2, Hôpital du Bocage, INSERM CIE1, CHRU Dijon, Université de Dijon, Dijon, France

    A. Burguet

  29. Université Paris Descartes and Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaire Paris Centre Site Cochin, DHU Risks in Pregnancy, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France

    P. H. Jarreau

  30. Department of Neonatology, Jeanne de Flandre Hospital, Lille CHRU, Lille, France

    P. Truffert

  31. Children’s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany

    R. F. Maier & L. Wohlers

  32. University Medical Center, Homburg, Germany

    M. Zemlin

  33. Institute of Quality Assurance Hesse, Eschborn, Germany

    B. Misselwitz

  34. Maternal and Child Health Institute, Marche University and Salesi Hospital, Ancona, Italy

    V. Carnielli

  35. Neonatal Intensive Care Unit, Ospedale degli Infermi, Rimini, Italy

    G. Ancora

  36. Neonatal Intensive Care Unit, University Hospital S. Orsola-Malpighi, Bologna, Italy

    G. Faldella

  37. Department of Pediatrics and Neonatology, Modena University Hospital, Modena, Italy

    F. Ferrari

  38. Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands

    A. van Heijst

  39. Department of Neonatology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands

    C. Koopman-Esseboom

  40. Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland

    J. Gadzinowski & A. Montgomery

  41. Department of Neonatology and Neonatal Infectious Diseases, Poznan University of Medical Sciences, Poznan, Poland

    J. Mazela & T. Pikuła

  42. EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal

    H. Barros, R. Costa & C. Rodrigues

  43. Newcastle University, Newcastle upon Tyne, UK

    A. Fenton

  44. European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany

    S. Mader, N. Thiele & J. M. Pfeil

  45. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

    S. Petrou & S. W. Kim

  46. Warwick Medical School, University of Warwick, Coventry, UK

    L. Andronis

Authors
  1. Adrien M. Aubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raquel Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samantha Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulrika Ådén
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marina Cuttini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Corine Koopman-Esseboom
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jo Lebeer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Heili Varendi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michael Zemlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Véronique Pierrat
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jennifer Zeitlin
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the SHIPS Research group

  • J. Lebeer
  • , P. Van Reempts
  • , E. Bruneel
  • , E. Cloet
  • , A. Oostra
  • , E. Ortibus
  • , I. Sarrechia
  • , K. Boerch
  • , P. Pedersen
  • , L. Toome
  • , H. Varendi
  • , M. Männamaa
  • , P. Y. Ancel
  • , A. Burguet
  • , P. H. Jarreau
  • , V. Pierrat
  • , P. Truffert
  • , R. F. Maier
  • , M. Zemlin
  • , B. Misselwitz
  • , L. Wohlers
  • , M. Cuttini
  • , I. Croci
  • , V. Carnielli
  • , G. Ancora
  • , G. Faldella
  • , F. Ferrari
  • , A. van Heijst
  • , C. Koopman-Esseboom
  • , J. Gadzinowski
  • , J. Mazela
  • , A. Montgomery
  • , T. Pikuła
  • , H. Barros
  • , R. Costa
  • , C. Rodrigues
  • , U. Aden
  • , E. S. Draper
  • , A. Fenton
  • , S. J. Johnson
  • , S. Mader
  • , N. Thiele
  • , J. M. Pfeil
  • , S. Petrou
  • , S. W. Kim
  • , L. Andronis
  • , J. Zeitlin
  • , A. M. Aubert
  • , C. Bonnet
  • , R. El Rafei
  •  & A. V. Seppänen

Contributions

R.C., S.J., U.A., M.C., C.K.-E., J.L., H.V., M.Z., V.P., J.Z., and the SHIPS Research group made substantial contributions to the conception and design and acquisition of data. A.M.A. and J.Z. analyzed the data. A.M.A., R.C., S.J., U.A., M.C., C.K.-E., J.L., H.V., M.Z., V.P., and J.Z. contributed to the interpretation of data, drafting the article, revising it critically for important intellectual content, and approved the final version to be published. Members of the SHIPS research group approved the final version to be published.

Corresponding author

Correspondence to Adrien M. Aubert.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

All study regions obtained ethical approval according to national legislation. The study was also approved by the French Advisory Committee on Use of Health Data in Medical Research (CCTIRS) and the French National Commission for Data Protection and Liberties (CNIL). Parents gave their written informed consent to participate in the study prior to any data collection.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aubert, A.M., Costa, R., Johnson, S. et al. Risk factors for cerebral palsy and movement difficulties in 5-year-old children born extremely preterm. Pediatr Res 94, 771–780 (2023). https://doi.org/10.1038/s41390-022-02437-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41390-022-02437-6

Search

Advanced search

Quick links