premature born infants are at increased risk for morbidity , longer hospital stay , and death as opposed to term born infants     [ 1 , 2 ] . much of the recent neonatal outcome literature focuses on infants with a very low birth weight ( < 1500 gram ) or infants born very prematurely ( < 32 weeks gestation )     [ 35 ] . several studies have mentioned lower cognitive scores , increased risk for attention deficit hyperactivity disorder , and delayed motor development in premature infants with very low birth weight     [ 38 ] . however , the group of infants born between 32 and 37 weeks of gestation is larger . in the netherlands approximately 30% of all infants are born at home , almost all at term . of the infants born in hospitals , approximately 7% to 11% it is known that infants born between 32 and 34 weeks have a four times greater risk of needing mechanical ventilation , ten times greater risk of developing a pneumothorax , and a 15 times greater risk of developing a sepsis as opposed to term born infants     [ 1 , 2 , 10 , 11 ] . there are only a few studies on long - term motor developmental outcome , that is , several years after hospital discharge , in infants born between 32 and 34 weeks     [ 2 , 12 , 13 ] . our hypothesis was that preterm infants born between 32 and 34 weeks are at risk for delayed motor development . from january 1999 till january 2005 , we included all 126 infants born between 32 0/7 and 34 0/7 weeks admitted to our neonatology ward , a medium and high care unit . during their stay , follow - up of motor development was offered by the attending physician and physical therapist as part of the post clinical developmental care program . we studied their motor development at the corrected ages of 3 , 6 , and 9 months and 4 years . written parental consent was obtained to describe the results in a manuscript . as follow - up of the psychomotor development is part of our standard care for premature born infants it was not necessary to ask for approval from the institutional medical ethical committee . stay one of the physical therapist took a full history and performed a first exam . after discharge , the alberta infant motor scale ( aims ) was performed by one of the physical therapists at the corrected age of 3 , 6 and 9 months . at the corrected age of 4 years the children the infants were assessed at the hospital in a separate room during 45 minutes , of which 20 minutes was pure observation time . the infants were randomly assessed by one of the physical therapists using the standardized aims and m - abc forms . the alberta infants motor scale ( aims ) is a reliable norm - referenced observational tool that has been validated for use from term to 18 months of age in infants both born premature and full term . aims measures qualitative aspects of movements without touching the infant and is sensitive to changes in an infants motor behavior . after observation of the infant , a raw aims score is based on the number of gross motor positions and movements that the infant has shown while being prone , supine , sitting , and standing . this raw score is translated to a percentile ranking that can be compared with normative age - matched samples of infants . since there are no dutch norm values yet , we used the cutoff point of the tenth percentile , as recommended by darrah et al . . below the tenth percentile the motor development was classified as abnormal . at the corrected age of 4 years the m - abc is a norm - referenced test that consists of 32 tasks divided into four age bands . for this study , we used band 1 ( 46 years ) . the tasks are divided into three sections : manual dexterity , ball skills , and static and dynamic balance . a child 's score on each test is converted to a standardized impairment score , based on centile bands for the child 's age group . an infant has a normal score when the total impairment score ( tis ) is at or above the 16th percentile . infants with a tis < 16 percentile were considered to be abnormal . in the final analysis we included patients for whom 2 or more assessments , of which one was the m - abc , were performed . the data were analyzed using spss for windows ( version 17.0 ; spss , chicago , il ) . to determine the correlation between aims and m - abc , we used the spearman 's rho correlation test . from january 1999 until january 2005 , 126 inborn infants , born after a gestational age between 32 0/7 and 34 0/7 weeks were admitted to the neonatology ward of the groene hart ziekenhuis , gouda , the netherlands and assessed by our physical therapists . none of the children had serious abnormalities on cranial ultra sound ( 10 had flaring grade 1   in the first week only , and two infants had an enlarged ventricle but still within normal values according to levene . . ninety percent of the patients of the study group were infants of caucasian parents . as far as recorded , 4% of the families had a lower socio - economic status ( ses ) . in the majority of 70 infants ( 51 infants ) , fourty - two infants ( 60% ) received breast milk for any period of time . of the infants who did not receive breast milk 7.4% had abnormal scores at 4 years of age , as opposed to the infants with breast milk where 21.4% had abnormal motor development at 4 years of age . of 70/126 infants ( 55% ) , the m - abc at 4 years of age was done next to at least one other assessment in the first year of life ( median of 3 assessments ) . the subgroup of infants with assessments at 4 years of age and at least one in the first year was further analyzed . due to a very limited number of assessments at 6 months of age , these results are not described . the outcome of all assessments is shown in figure 1 . at 3 months of age 8/66 infants assessed ( 12% ) showed an abnormal motor development , only one of these infants still had an abnormal development at four years of age . at the corrected age of 9 months , 20/62 infants scored abnormal , of which 20% ( 4 infants ) still scored abnormal at 4 years of age . the percentage of children with a normal motor development was 68% and 83% , respectively at 9 months and 4 years of corrected age . there was no statistical correlation between the motor development at 3 months or 9 months and 4 years ( p = .26 and p = .21 , resp . ) . six infants had an apgar score below 7 after 5 minutes ( 6% ) . at 3 months , one of these infants scored abnormal but normal at four years of age . at the corrected age of 4 years an abnormal assessment at 3 or 9 months of age evolved to normal motor developmental outcome in 80% at 4 years of age . on the other hand , 10% of the children who scored normal in the first year showed a delayed / abnormal motor development at the age of four years . our results suggest that long - term follow - up of these late preterm born infants is necessary , as the assessments in the first year do not predict the long - term outcome . our results show that almost 20% of the infants born late preterm has an abnormal assessment at the age of 4 , which is comparable with the outcome of elbw infants     . variables as ses , presence of chorioamnionitis , breast milk , and ethnicity have been described to be of influence on motor development     [ 2022 ] . in our study there seems to be no effect of gestational age , birth weight , apgar score , ses , or sex on motor developmental outcome , but the numbers were too small for statistical analysis . in our study pathological exam of the placenta was not routinely done , leading to too small numbers for analysis . in our study group , on the contrary to other studies , breast milk was not protective for abnormal motor development . it is possible that we did not find the same results as other studies because of the small study group . gestational age range in this study was also very narrow which could also explain that no effect was seen for this item . restiffe and gherpell , described the use of the aims in 43 infants , ranging from 26 to 36 5/7 weeks . they concluded that all premature infants should be assessed at corrected ages to prevent children from being wrongly diagnosed with developmental delay . they found that dutch children in the age of 012 months scored significantly lower on the aims than the canadian reference group of 19901992 . also , they stated that the aims is the most sensitive in the first year of life . , assessed 800 preterm infants with the aims and found evidence of a specific way of early motor developmental in the first 18 months of life of these infants . they suggested that standard gross motor developmental scales should be adjusted for preterm infants . as shown by the above - mentioned authors it is difficult to compare preterm infants to term infants . furthermore , our results show that infants that have been assessed in the first year of life and scored abnormal can evolve to normal motor development at four years of age . on the other hand , a normal score the first year can lead to abnormal motor development later on . it is possible , however , that the sample size of our study is   too small to rule out chance in this respect . it is possible that the percent with abnormal motor development at each age is within the range expected by chance with this sample size . as there are no data described for this age group , we can not compare this . there was a relatively high rate of loss to follow up in the total group of 126 infants . of the group with an assessment at four years , several infants were not assessed at all study moments in the first year . possibly , these infants had motor developmental difficulties and may have been seen by physical therapists nearby their home , whose assessments were not available for this study . another possibility is that the infants were developing well and the parents did not see the necessity of a motor assessment . second limitation is not blinding the investigators to the gestational age , which may have led to a bias . our study results show that assessments in the first year of life in late preterm infants do not predict their motor developmental outcome at 4 years of age . however , we do suggest assessments at 3 , 9 , months and at 4 years of age . assessments in the first year seem warranted to establish motor developmental delay , in order to provide for the most optimal support in the motor development of this potentially vulnerable group of infants . possibly assessment at a later age ( for instance at 7 to 9 years ) is warranted to evaluate later outcome in fine motor skills .