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Objective This study aimed to examine attention and processing speed outcomes in very preterm (VPT; <32 weeks' gestational age) or very low birth weight (VLBW; <1500 g) children, and to assess the ability of brain abnormalities measured by neonatal magnetic resonance imaging (MRI) to predict outcome in these domains. Methods A cohort of 198 children born <30 weeks' gestational age and/or <1250 g and 70 term controls were examined. Neonatal MRI scans at term equivalent age were quantitatively assessed for white matter, cortical gray matter, deep gray matter, and cerebellar abnormalities. Attention and processing speed were assessed at 7 years using standardized neuropsychological tests. Group differences were tested in attention and processing speed, and the relationships between these cognitive domains and brain abnormalities at birth were investigated. Results At 7 years of age, the VPT/VLBW group performed significantly poorer than term controls on all attention and processing speed outcomes. Associations between adverse attention and processing speed performances at 7 years and higher neonatal brain abnormality scores were found; in particular, white matter and deep gray matter abnormalities were reasonable predictors of long-term cognitive outcomes. Conclusion Attention and processing speed are significant areas of concern in VPT/VLBW children. This is the first study to show that adverse attention and processing speed outcomes at 7 years are associated with neonatal brain pathology.

While attention impairments are commonly observed in very preterm (<32 weeks’ gestational age) children, neuroanatomical correlates of these difficulties are unclear. We aimed to determine whether the microstructural organization of key white matter tracts thought to be involved in attention (cingulum bundle, superior longitudinal fasciculi, reticular activating system, and corpus callosum) were altered in very preterm children compared with term-born controls. We also aimed to determine whether alterations in microstructural organization of these tracts were associated with attention functioning in very preterm children. One hundred and forty-nine very preterm children and 36 term-born controls underwent neuroimaging and assessment of their attention abilities at 7 years. Constrained spherical deconvolution and probabilistic tractography was used to identify the key white matter tracts. Altered microstructural organization and reduced tract volume within reticular activating system and corpus callosum were found in the very preterm group compared with the control group. Diffusion and volume changes in the cingulum bundle, superior longitudinal fasciculi, reticular activating system, and corpus callosum were related to variations in attention functioning in the very preterm children. These findings emphasize that white matter tract integrity is associated with later attentional abilities in very preterm children.