Spontaneous movements in the supine position of preterm infants with intellectual disability

Gestational age and risk of intellectual disability: a population-based cohort study

OBJECTIVE

To examine the association between gestational age at birth and risk of clinically diagnosed intellectual disability (ID) week by week to provide a detailed description of ID risk across the entire range of gestational ages and by severity of ID.

METHODS

All individuals born alive in Sweden 1974-2017 were prospectively followed up from birth until 2017 using national registers. The HRs for ID according to weekly gestational age and gestational age categories were determined using Cox models. Sibling analyses were conducted to adjust for familial confounding.

RESULTS

The study included 3 572 845 live births. During the follow-up, 26 596 ID cases were registered. The adjusted weekly estimates showed a gradual increase in risk of ID from week 40 to week 24 (adjusted HR_37weeks=1.80 (1.74 to 1.87), aHR_32weeks=3.93 (3.73 to 4.13), aHR_28weeks=7.53 (6.95 to 8.16), aHR_24weeks=21.58 (18.62 to 25.00)) and from week 41 onwards (aHR_42weeks=1.26 (1.19 to 1.32)), with statistically significantly higher risks across the range of gestational age compared with infants born at week 40. The associations were consistent in mild, moderate and severe/profound ID but most prominent for severe/profound ID.

CONCLUSION

The risk of ID increased weekly as the date of delivery moved away from 40 weeks, both preterm and post-term. The results remained robust after detailed adjustment for confounding, including familial confounding.

Toward Predicting Infant Developmental Outcomes From Day-Long Inertial Motion Recordings

As improvements in medicine lower infant mortality rates, more infants with neuromotor challenges survive past birth. The motor, social, and cognitive development of these infants are closely interrelated, and challenges in any of these areas can lead to developmental differences. Thus, analyzing one of these domains - the motion of young infants - can yield insights on developmental progress to help identify individuals who would benefit most from early interventions. In the presented data collection, we gathered day-long inertial motion recordings from N = 12 typically developing (TD) infants and N = 24 infants who were classified as at risk for developmental delays (AR) due to complications at or before birth. As a first research step, we used simple machine learning methods (decision trees, k-nearest neighbors, and support vector machines) to classify infants as TD or AR based on their movement recordings and demographic data. Our next aim was to predict future outcomes for the AR infants using the same simple classifiers trained from the same movement recordings and demographic data. We achieved a 94.4% overall accuracy in classifying infants as TD or AR, and an 89.5% overall accuracy predicting future outcomes for the AR infants. The addition of inertial data was much more important to producing accurate future predictions than identification of current status. This work is an important step toward helping stakeholders to monitor the developmental progress of AR infants and identify infants who may be at the greatest risk for ongoing developmental challenges.

Differences in Spontaneous Leg Movement Patterns Between Infants With Typical Development and Infants at Risk for Developmental Delay: Cross-sectional Observation Prior to Sitting Onset

Purpose

To investigate differences in the patterns of supine spontaneous leg movements produced before sitting onset between infants with typical development (TD) and infants at risk for developmental delay (AR).

Method

Cross-sectional, observational study. Thirty-five infants were included, 18 infants with TD (130.4 ±38.0 days) and 17 infants AR (124.1± 65.7 days). Infants were placed in the supine position and video taped for 4 to 5 minutes while in an alert, content state. After the recording, videos were coded frame by frame to identify the type of each leg movement produced: single flexion, single extension, alternate flexion, alternate extension, parallel flexion, parallel extension, leg wave, leg circle, leg thump, foot rub, foot flexion, or foot rotation.

Results

Unilateral movements (single flexion and single extension) were the most common leg movements in TD group. Infants AR produced a significantly lower proportion of unilateral and foot rub movements than infants with TD.

Conclusion

These results provide a foundation of the types of leg movement pattern differences to build on in future research. Knowledge about differences in spontaneous movement patterns between infants AR and infants with TD has relevance both for early identification of neuromotor impairment and clinical practice.

Posture and movement in very preterm infants at term age in and outside the nest

OBJECTIVE

The objective of this study is to evaluate the use of nests on general movements (GM) and posture in very preterm infants at term age.

METHOD

Seventeen high-risk preterm infants-less than 30 weeks of gestation (GA)-underwent a video recording, lying in supine position, with or without nest. Posture, GM quality, and movements made around the child's midline, as well as abrupt movements and frozen postures-in extension or flexion of the four limbs-were analyzed.

RESULTS

Nest did not modify quality of GM. Children significantly adopted a curled-up position. The nest system was associated with an increase in movements toward or across the midline, as well as reduction of the hyperextension posture and head rotation movements. Frozen postures in flexion or extension, as well as abrupt movements of the four limbs, were reduced but not significantly.

CONCLUSIONS

Nest helps very preterm infants to adopt semi-flexed posture and facilitates movements across the midline and reduces movements of spine hyperextension, without GM global quality modifications.

Characterization and intervention for upper extremity exploration & reaching behaviors in infancy

This article aims to: 1) highlight general exploration, reaching, and object exploration behaviors as key activities of daily living in infancy, 2) describe how knowledge of early warning signs for these behaviors may improve early assessment, and 3) discuss interventions that may advance performance of these behaviors. Early intervention should focus on improving performance of these behaviors because: a) these early, interrelated upper extremity behaviors serve an integral role in global learning and development in infancy, b) among at-risk populations, differences have been observed in the quantity and quality of performance of these behaviors and, in many cases, these differences are associated with related perceptual-motor and cognitive delays. This article highlights how early assessment and intervention can target these key early behaviors in populations at risk for upper extremity disabilities, such as those born preterm, with Down syndrome, brachial plexus palsy, or arthrogryposis multiplex congentia.