Objective:

To evaluate cognitive outcomes at preschool age in very preterm infants with normal MRI findings at term-equivalent age and identify neonatal and maternal risk factors associated with adverse cognitive outcomes.

Approach:

• Study Design: Retrospective cohort study of 296 very preterm infants born <32 weeks of gestation with normal MRI findings at term-equivalent age.
• Cognitive Assessment: Cognitive outcomes assessed at 5 years using standardized intelligence tests.
• Statistical Analysis: Logistic regression used to analyze associations between neonatal, perinatal, and maternal factors with cognitive outcomes.

Key Findings:

• Median IQ was 98 (IQR 87–108); 18.9% had an IQ<85 and 5.1% had an IQ<70.
• Male sex (OR 2.0), preterm premature rupture of membranes (OR 2.9), and early-onset sepsis were associated with adverse outcomes.
• Low maternal education (OR 7.2, 95% CI 2.5 to 20.8) and a native language other than German (OR 4.0, 95% CI 2.0 to 7.9) were strongly associated with lower cognitive performance.
• Gestational age and birth weight were not significantly associated with outcomes.

Interpretation:

Most very preterm infants with normal MRI findings achieved age-appropriate cognitive performance, but a clinically relevant subgroup remained at risk for cognitive difficulties.

Limitations:

• Retrospective design may limit causal inferences.
• Single-center study may affect generalizability.

Conclusion:

Targeted developmental surveillance and early intervention are warranted for very preterm infants to optimize long-term cognitive development.