Aim The aim of this study was to establish the prevalence of autistic traits at childhood neurodevelopmental assessment in a premature cohort and to assess associated perinatal exposures. Methods An observational retrospective case-control study was conducted in a single tertiary neonatal unit. All infants born weighing =1500 grams and/or =32/40 weeks who attended for neurodevelopmental assessment in 2019 were eligible. Results 96 preterm infants met the inclusion criteria. 22 (23%) in the case group demonstrated clinical features of autism at early childhood assessment. The remaining 74 acted as a control group. In the case group 18 (82%) were male. There was no difference in rate of multiple births between the groups. There was no statistically significant difference in maternal age or indication for delivery. Male phenotype (p=0.003), non-Irish ethnicity (p=0.005), vaginal delivery (p=0.005) and abnormal cranial ultrasound (p=0.009) occurred more frequently in the case group. Use of assistive reproductive technologies occurred less frequently in the case group (p=0.047). In the case group, 10/14 of the composite scores measured on Bayleys-3 at a median (IQR) age of 32 (31-35) months showed statistically significant differences (p<0.003). Discussion Our study strongly supports increasing awareness of the association between prematurity and autism. It highlights the need for targeted neurodevelopmental follow-up to support early detection of autism, allowing for timely intervention. Further investigation in a larger prospective cohort may further delineate the various perinatal risk factors for autism.