The long-term scarring burden of preterm infants undergoing modern neonatal intensive care is not known. This observational cohort study aimed to document the presence and pattern of scarring in children born <30 weeks’ gestation or <1500 g birth weight and cared for at the National Women’s Health neonatal intensive care unit, Auckland, New Zealand. Children were examined at 7 years’ corrected age and the presence, size, number and distribution of scars documented. Scarring was seen in 90% of 129 children assessed, with 81% having multiple scars, 60% having large scars (85% of whom had no history of major neonatal surgery) and 75% having more than one body area scarred. Scarring was more common in boys and in children of non-European ethnicity. Despite modern neonatal intensive care practices, children born very preterm are frequently and extensively scarred at school age.