Extremely preterm children more likely to develop motor impairment
1. This prospective cohort study showed that children born extremely premature (EP) or at an extremely low birth weight (ELBW) were more likely to develop cerebral palsy (CP) or non-CP motor impairment at 8 years' corrected age when compared to matched controls born at term.
2. The increase in rates of motor impairment in children born EP or ELBW during the study was attributed to non-cerebral palsy motor impairment.
Evidence Rating Level: 1 (Excellent)
Study Rundown: With increasing medical intervention, more infants born EP (i.e. <28 weeks gestational age) or ELBW (i.e. <1000g) are surviving into childhood. However, these infants often go on to develop motor problems, including CP, as well as other motor impairments. This study followed infants born EP or ELBW, and compared their motor function to matched controls born full-term. Three cohorts during a 1991-2005 study periods were compared. Results indicated that the EP and ELBW infants were more likely to develop motor impairments than their full-term counterparts. The rate of motor impairments among EP and ELBW children rose during the study period due to increases non-CP motor impairment. This study's strengths included a prospective data collection, as well as high follow-up rates, but this study was limited by changing outcome measures between the cohorts. Further studies regarding motor impairments in EP and ELBW should be conducted to further elucidate the reasons for the increases seen here.
Relevant Reading: Neurodevelopmental outcomes of extremely preterm infants
In-Depth [prospective cohort]: This study was conducted as part of the Victorian Infant Collaborative Study. Researchers recruited cohorts of children born EP or ELBW in Victoria, Australia during 3 different time periods: 1991-1992, 1997, and 2005. Control groups were recruited of normal birth weight children and matched for factors including sex, insurance status, and mother's country of birth. Perinatal data was extracted from medical records and all children were invited to attend a developmental assessment at 8 years of age, which included a Movement Assessment Battery for Children (MABC, MABC-2) motor assessment. To grade children with CP, the Gross Motor Function Classification Scale (GMFCS) was used. Increased survival was noted among EP and ELBW infants over time (54% in 1991 to 64% in 2005). EP and ELBW children were significantly more likely than children born at term to develop motor impairment (37% vs. 7% for 2005 cohort, OR: 8.00, 95%CI: 4.33-15.2). While rates of CP remained constant over the 3 cohorts, non-CP motor impairments increased over time (11% in 1991 to 26% in 2005).
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