National population-based cohort study found that visual-motor integration was commonly affected in extremely preterm born children at six-and-a-half years

Research output: Contribution to journalArticle


Aim: This study aimed to explain the relationship between visual-motor integration (VMI) abilities and extremely preterm (EPT) birth, by exploring the influence of perinatal variables, cognition, manual dexterity and ophthalmological outcomes. Methods: This was part of the population-based national Extremely Preterm Infant Study in Sweden (EXPRESS) study. We studied 355 children, born at a gestational age of <27 weeks from April 2004 to March 2007, and 364 term-born controls. At six-and-a-half years of age, we assessed VMI, cognitive function, motor skills and vision. VMI impairment was classified as <-1 standard deviation (SD). Results: The mean (SD) VMI score was 87 (±12) in preterm children compared to 98 (±11) in controls (p < 0.001). VMI impairment was present in 55% of preterm infants and in 78% of children born at 22-23 weeks. Male sex and postnatal steroids showed a weak association with poorer visual-motor performance, whereas low manual dexterity and cognitive function showed a stronger association. Conclusion: Poor VMI performance was common in this EXPRESS cohort of children born EPT. Its strong association to cognition and manual dexterity confirms that all of these factors need to be taken into account when evaluating risks in preterm born children.


  • Jenny Bolk
  • Ylva Fredriksson Kaul
  • Lena Hellström-Westas
  • Karin Stjernqvist
  • Nelly Padilla
  • Fredrik Serenius
  • Kerstin Hellgren
  • Ulrika Åden
External organisations
  • Uppsala University Hospital
  • Karolinska Institutet
  • Umeå University
  • Södersjukhuset
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Pediatrics


  • Children, Extremely preterm, Outcome, Perinatal risk factors, Visual-motor integration
Original languageEnglish
Pages (from-to)831-837
JournalActa Paediatrica, International Journal of Paediatrics
Issue number5
Early online date2018
Publication statusPublished - 2018
Publication categoryResearch