ABBREVIATIONS MNDMinor neurological dysfunction MABC-2 Movement Assessment Battery for Children -2nd edition AIM To elucidate the relation between motor impairment and other developmental deficits in very preterm-born children without disabling cerebral palsy and term-born comparison children at 5 years of (corrected) age.METHOD In a prospective cohort study, 165 children (81 very preterm-born and 84 term-born)were assessed with the Movement Assessment Battery for Children -2nd edition, Touwen's neurological examination, the Wechsler Preschool and Primary Scale of Intelligence, processing speed and visuomotor coordination tasks of the Amsterdam Neuropsychological Tasks, and the Strengths and Difficulties Questionnaire.RESULTS Motor impairment (≤15th centile) occurred in 32% of the very preterm-born children compared with 11% of their term-born peers (p=0.001). Of the very preterm-born children with motor impairment, 58% had complex minor neurological dysfunctions, 54% had low IQ, 69% had slow processing speed, 58% had visuomotor coordination problems, and 27%, 50%, and 46% had conduct, emotional, and hyperactivity problems respectively. Neurological outcome (odds ratio [OR]=41.7, 95% confidence intervals [CI] 7.5-232.5) and Full-scale IQ (OR=7.3, 95% CI 1.9-27.3) were significantly and independently associated with motor impairment. Processing speed (OR=4.6, 95% CI 1.8-11.6) and attention (OR=3.2, 95% CI 1.3-7.9) were additional variables associated with impaired manual dexterity. These four developmental deficits mediated the relation between preterm birth and motor impairment.INTERPRETATION Complex minor neurological dysfunctions, low IQ, slow processing speed, and hyperactivity/inattention should be taken into account when very preterm-born children are referred for motor impairment.