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Lambert G, Husein N, Fehlings D, Andersen J, Oskoui M, Shevell M. Early Biomarkers in the Prediction of Later Functional Impairment in Preterm Children With Cerebral Palsy. Pediatr Neurol 2024; 161:55-60. [PMID: 39276578 DOI: 10.1016/j.pediatrneurol.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/17/2024] [Accepted: 08/19/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND To identify early biomarkers that could predict later functional capabilities in preterm children with later cerebral palsy (CP). METHODS Data from 968 preterm children with later CP were extracted from the Canadian Cerebral Palsy Registry. One hundred eighty-two infants were born before 27 weeks of gestation, 461 infants were born between 27 and 33 weeks, and 325 infants were born between 34 and 37 weeks. Univariate and chi-square analyses were conducted to measure the association between early objective biomarkers and later mobility status defined as Gross Motor Function Classification System (GMFCS) levels IV and V as well as tube feeding dependence. RESULTS Univariate analysis suggested no significant association between GMFCS levels IV and V or impaired feeding status and bilateral white matter injury on magnetic resonance imaging, high-grade intraventricular hemorrhage on head ultrasound, chorioamnionitis, a birth weight of 1000 to 1500 g or <1000 g, as well as an Apgar score of ≤5 at five minutes of life. Similar results were found for gestational age <28 weeks at birth. Only a significant association between GMFCS levels IV and V and a cord or first hour of life pH of ≤7 was reported (mobility status: odds ratio [OR] 1.95, 95% confidence interval [CI] 1.09 to 3.57) and feeding status: OR 2.23, CI 0.97 to 4.65)]. CONCLUSIONS Prediction of functional outcomes based on specific early biomarkers appears hard to obtain in children with CP born preterm in contrast to those born at term. The complications and causal pathways inherent to prematurity may contribute to making prognostication less determinant.
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Affiliation(s)
- Gabrielle Lambert
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada.
| | - Nafisa Husein
- Canadian Cerebral Palsy Registry, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Darcy Fehlings
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Oskoui
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Michael Shevell
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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Feddahi N, Hartmann L, Felderhoff-Müser U, Roy S, Lampe R, Maiti KS. Neonatal Exhaled Breath Sampling for Infrared Spectroscopy: Biomarker Analysis. ACS OMEGA 2024; 9:30625-30635. [PMID: 39035909 PMCID: PMC11256302 DOI: 10.1021/acsomega.4c02635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024]
Abstract
Monitoring health conditions in neonates for early therapeutic intervention in case deviations from physiological conditions is crucial for their long-term development. Due to their immaturity preterm born neonates are dependent on particularly careful physical and neurological diagnostic methods. Ideally, these should be noninvasive, noncontact, and radiation free. Infrared spectroscopy was used to analyze exhaled breath from 71 neonates with a special emphasis on preterm infants, as a noninvasive, noncontact, and radiation-free diagnostic tool. Passive sample collection was performed by skilled clinicians. Depending on the mode of respiratory support of infants, four different sampling procedures were adapted to collect exhaled breath. With the aid of appropriate reference samples, infrared spectroscopy has successfully demonstrated its effectiveness in the analysis of breath samples of neonates. The discernible increase in concentrations of carbon dioxide, carbon monoxide, and methane in collected samples compared to reference samples served as compelling evidence of the presence of exhaled breath. With regard to technical hurdles and sample analysis, samples collected from neonates without respiratory support proved to be more advantageous compared to those obtained from intubated infants and those with CPAP (continuous positive airway pressure). The main obstacle lies in the significant dilution of exhaled breath in the case of neonates receiving respiratory support. Metabolic analysis of breath samples holds promise for the development of noninvasive biomarker-based diagnostics for both preterm and sick neonates provided an adequate amount of breath is collected.
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Affiliation(s)
- Nadia Feddahi
- Center
for Translational and Neurobehavioural Sciences CTNBS, Department
of Pediatrics I, Neonatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany
| | - Lea Hartmann
- Center
for Translational and Neurobehavioural Sciences CTNBS, Department
of Pediatrics I, Neonatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany
| | - Ursula Felderhoff-Müser
- Center
for Translational and Neurobehavioural Sciences CTNBS, Department
of Pediatrics I, Neonatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany
| | - Susmita Roy
- Research
Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Pediatric
Neuroorthopaedics, Department of Orthopaedics and Sports Orthopaedics,
TUM School of Medicine and Health, University Hospital Rechts der
Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Renée Lampe
- Research
Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Pediatric
Neuroorthopaedics, Department of Orthopaedics and Sports Orthopaedics,
TUM School of Medicine and Health, University Hospital Rechts der
Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
- Markus
Würth Professorship, Technical University
of Munich, Ismaninger
Straße 22, 81675 Munich, Germany
| | - Kiran Sankar Maiti
- TUM
School of Natural Sciences, Department of Chemistry, Technical University of Munich, 85748 Garching, Germany
- Max-Planck-Institut
für Quantenoptik, Hans-Kopfermann-Straße 1, 85748 Garching, Germany
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Nyakotey DA, Clarke AM, Cormack BE, Bloomfield FH, Harding JE. Postnatal growth and neurodevelopment at 2 years' corrected age in extremely low birthweight infants. Pediatr Res 2024; 96:436-449. [PMID: 38337041 PMCID: PMC11343699 DOI: 10.1038/s41390-024-03054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 11/28/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Faltering postnatal growth in preterm babies is associated with adverse neurodevelopment. However, which growth reference is most helpful for predicting neurodevelopment is unknown. We examined associations between faltering growth and developmental delay in extremely low birthweight (ELBW) infants. METHODS We categorized faltering growth (z-score decrease ≥0.8 for weight/length, >1 for head circumference) between birth, 4 weeks, 36 weeks' postmenstrual age and 2 years' corrected age using fetal (Fenton, UK-WHO and Olsen) and healthy preterm (INTERGROWTH-21st) references. Associations between faltering growth and developmental delay were examined using binary logistic regression and area under the receiver operating curve (AUC). RESULTS In 327 infants, Olsen charts identified the highest prevalence of faltering growth (weight 37%, length 63%, head 45%). Agreement in classification was higher amongst fetal references (kappa coefficient, ĸ = 0.46-0.94) than between INTERGROWTH-21st and fetal references (ĸ = 0.10-0.81). Faltering growth in all measures between 4-36 weeks (odds ratio, OR 2.0-4.7) compared with other time intervals (OR 1.7-2.7) were more strongly associated with developmental delay, particularly motor delay (OR 2.0-4.7). All growth references were poorly predictive of developmental delay at 2 years (AUC ≤ 0.62). CONCLUSIONS Faltering postnatal growth in ELBW infants is associated with, but is poorly predictive of, developmental delay at 2 years. IMPACT In babies born preterm, different growth references result in wide variation in categorization of faltering postnatal growth. Faltering growth in weight, length, and head circumference from 4 weeks to 36 weeks' postmenstrual age are associated with developmental delay at 2 years' corrected age, particularly motor delay. However, postnatal growth is a poor predictor of later developmental delay in extremely low birthweight infants irrespective of the growth reference used.
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Affiliation(s)
- David A Nyakotey
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand
| | - Angelica M Clarke
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand
| | - Barbara E Cormack
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand
- Starship Child Health, Auckland City Hospital, Auckland, 1023, New Zealand
| | | | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, 1023, New Zealand.
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Prasad Gupta M, Gupta D, Usman A. Post-term Birth and Developmental Coordination Disorder: A Narrative Review of Motor Impairments in Children. Cureus 2024; 16:e63211. [PMID: 39070519 PMCID: PMC11278065 DOI: 10.7759/cureus.63211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
A prevalent long-term medical condition in children that is rarely understood and acknowledged in educational contexts is developmental coordination disorder (DCD), which is one of the most prevalent conditions in school-aged children. Mild-to-severe abnormalities in muscle tone, posture, movement, and the learning of motor skills are associated with motor disorders. Early detection of developmental abnormalities in children is crucial as delayed motor milestones during infancy might indicate a delay in both physical and neurological development. To overcome the current condition of motor impairment, obstructing their risk factors is important to prevent the development of disability, which is already determined in the prenatal and perinatal period. Concerning the relationship with gestational age, the majority of the studies reported a relationship between DCD and preterm children. However, the entire range of gestational age, including post-term birth, has not been studied. The risk of developmental consequences such as cognitive impairments, major mental diseases, attention-deficit/hyperactivity disorder, autism spectrum disorder, and other behavioral and emotional problems increases in post-term birth, according to prior studies. Thus, this review aims to provide an overview of information linking post-term birth to children's motor impairment, with a focus on DCD. A thorough systemic review was conducted on online databases, and only a few studies were found on the association with post-term children. Insufficient evidence made it necessary to examine more post-term cohorts in adolescence to fully determine the long-term health concerns and develop therapies to mitigate the detrimental effects of post-term deliveries.
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Affiliation(s)
- Manish Prasad Gupta
- Pediatrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, CHN
| | - Dhiraj Gupta
- Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Ali Usman
- General Surgery, Nishtar Medical University, Multan, PAK
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FitzGerald TL, Cameron KL, Albesher RA, Mentiplay BF, Mainzer RM, Burnett AC, Treyvaud K, Clark RA, Anderson PJ, Cheong JL, Doyle LW, Spittle AJ. Associations between physical activity and development in preschool-aged children born <30 weeks' gestation: a cohort study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326045. [PMID: 38408793 DOI: 10.1136/archdischild-2023-326045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To investigate the effect of physical activity (PA) on development (motor, cognitive, social-emotional) in children 4-5 years old born <30 weeks' gestation, and to describe subgroups of children at risk of low PA in this cohort. DESIGN Longitudinal cohort study. PATIENTS 123 children born <30 weeks were recruited at birth and assessed between 4 and 5 years' corrected age. MAIN OUTCOME MEASURES Development was assessed using the Movement Assessment Battery for Children, Second Edition (MABC-2), Little Developmental Coordination Disorder Questionnaire (L-DCDQ), Wechsler Preschool and Primary Scale of Intelligence (Fourth Edition; WPPSI-IV), and Strengths and Difficulties Questionnaire (SDQ). To measure PA, children wore an accelerometer and parents completed a diary for 7 days. Effects of PA on developmental outcomes, and associations between perinatal risk factors and PA, were estimated using linear regression. RESULTS More accelerometer-measured PA was associated with better MABC-2 aiming and catching scores (average standard score increase per hour increase in PA: 0.54, 95% CI 0.11, 0.96; p=0.013), and lower WPPSI-IV processing speed index scores (average composite score decrease per hour increase in PA: -2.36, 95% CI -4.19 to -0.53; p=0.012). Higher accelerometer-measured PA was associated with better SDQ prosocial scores. Major brain injury in the neonatal period was associated with less moderate-vigorous and less unstructured PA at 4-5 years. CONCLUSIONS Higher levels of PA are associated with aspects of motor, cognitive and social-emotional skill development in children 4-5 years old born <30 weeks. Those with major brain injury in the neonatal period may be more vulnerable to low PA at preschool age.
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Affiliation(s)
- Tara L FitzGerald
- Department of Physiotherapy, The University of Melbourne, Carlton, Victoria, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kate L Cameron
- Department of Physiotherapy, The University of Melbourne, Carlton, Victoria, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Reem A Albesher
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Rheanna M Mainzer
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Alice C Burnett
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Neonatal Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Karli Treyvaud
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Psychology, Counselling and Therapy, La Trobe University, Melbourne, Victoria, Australia
| | - Ross A Clark
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jeanie Ly Cheong
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Neonatal Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Neonatal Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Neonatal Research, The Royal Women's Hospital, Parkville, Victoria, Australia
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Brasseler M, Mischak H, Schanstra JP, Michel JM, Pape L, Felderhoff-Müser U. Gestational Age-Related Urinary Peptidome Changes in Preterm and Term Born Infants. Neonatology 2024; 121:305-313. [PMID: 38382482 DOI: 10.1159/000535355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/15/2023] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Preterm infants are at risk for a variety of somatic and neurological disorders. In recent years, biofluid proteomics has emerged as a potential diagnostic tool for biomarker analysis. The aim of this study was to determine gestational age (GA)-related patterns of the urinary peptidome in preterm infants for researching potential novel prognostic biomarkers. METHODS We performed urinary peptidomics in longitudinal samples of 24 preterm (mean GA weeks 28 + 1 [24+1-31 + 6]) and 27 term born controls (mean GA weeks 39 + 2 [37+0-41 + 1]) using capillary electrophoresis combined with mass spectrometry (CE-MS). Peptides were sequenced using CE-MS/MS or LC-MS/MS analysis and were deposited, matched, and annotated in a Microsoft SQL database for statistical analysis. We compared their abundance in urine of preterm and term born infants and performed a validation analysis as well as correlations to GA and clinical risk scores. RESULTS Our results confirmed significant differences in the abundance of peptides and the hypothesis of age-dependent urinary peptidome changes in preterm and term infants. In preterm infants, SLC38A10 (solute carrier family 38 member 10) is one of the most abundant peptides. Combined urinary peptides correlated with clinical risk scores (p < 0.05). CONCLUSION This is the first study reporting GA-related urinary peptidome changes of preterm infants detected by CE-MS and a modulation of the peptidome with GA. Further research is required to locate peptidome clusters correlated with specific clinical complications and long-term outcome. This may identify preterm infants at higher risk for adverse outcome who would benefit from early intervention.
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Affiliation(s)
- Maire Brasseler
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology and Centre for Translational and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Harald Mischak
- Mosaiques Diagnostics GmbH, Hannover, Germany, BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), Institute of Cardiovascular and Metabolic Disease, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Juliane Marie Michel
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology and Centre for Translational and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Lars Pape
- Department of Pediatrics II, Nephrology, Gastroenterology, Hepatology, Transplantation, Endocrinology and Sonography, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology and Centre for Translational and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Orton J, Doyle LW, Tripathi T, Boyd R, Anderson PJ, Spittle A. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2024; 2:CD005495. [PMID: 38348930 PMCID: PMC10862558 DOI: 10.1002/14651858.cd005495.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Infants born preterm are at increased risk of cognitive and motor impairments compared with infants born at term. Early developmental interventions for preterm infants are targeted at the infant or the parent-infant relationship, or both, and may focus on different aspects of early development. They aim to improve developmental outcomes for these infants, but the long-term benefits remain unclear. This is an update of a Cochrane review first published in 2007 and updated in 2012 and 2015. OBJECTIVES Primary objective To assess the effect of early developmental interventions compared with standard care in prevention of motor or cognitive impairment for preterm infants in infancy (zero to < three years), preschool age (three to < five years), and school age (five to < 18 years). Secondary objective To assess the effect of early developmental interventions compared with standard care on motor or cognitive impairment for subgroups of preterm infants, including groups based on gestational age, birthweight, brain injury, timing or focus of intervention and study quality. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and trial registries in July 2023. We cross-referenced relevant literature, including identified trials and existing review articles. SELECTION CRITERIA Studies included randomised, quasi-randomised controlled trials (RCTs) or cluster-randomised trials of early developmental intervention programmes that began within the first 12 months of life for infants born before 37 weeks' gestational age (GA). Interventions could commence as an inpatient but had to include a post discharge component for inclusion in this review. Outcome measures were not prespecified, other than that they had to assess cognitive outcomes, motor outcomes or both. The control groups in the studies could receive standard care that would normally be provided. DATA COLLECTION AND ANALYSIS Data were extracted from the included studies regarding study and participant characteristics, timing and focus of interventions and cognitive and motor outcomes. Meta-analysis using RevMan was carried out to determine the effects of early developmental interventions at each age range: infancy (zero to < three years), preschool age (three to < five years) and school age (five to < 18 years) on cognitive and motor outcomes. Subgroup analyses focused on GA, birthweight, brain injury, time of commencement of the intervention, focus of the intervention and study quality. We used standard methodological procedures expected by Cochrane to collect data and evaluate bias. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS Forty-four studies met the inclusion criteria (5051 randomly assigned participants). There were 19 new studies identified in this update (600 participants) and a further 17 studies awaiting outcomes. Three previously included studies had new data. There was variability in the focus and intensity of the interventions, participant characteristics, and length of follow-up. All included studies were either single or multicentre trials and the number of participants varied from fewer than 20 to up to 915 in one study. The trials included in this review were mainly undertaken in middle- or high-income countries. The majority of studies commenced in the hospital, with fewer commencing once the infant was home. The focus of the intervention programmes for new included studies was increasingly targeted at both the infant and the parent-infant relationship. The intensity and dosages of interventions varied between studies, which is important when considering the applicability of any programme in a clinical setting. Meta-analysis demonstrated that early developmental intervention may improve cognitive outcomes in infancy (developmental quotient (DQ): standardised mean difference (SMD) 0.27 standard deviations (SDs), 95% confidence interval (CI) 0.15 to 0.40; P < 0.001; 25 studies; 3132 participants, low-certainty evidence), and improves cognitive outcomes at preschool age (intelligence quotient (IQ); SMD 0.39 SD, 95% CI 0.29 to 0.50; P < 0.001; 9 studies; 1524 participants, high-certainty evidence). However, early developmental intervention may not improve cognitive outcomes at school age (IQ: SMD 0.16 SD, 95% CI -0.06 to 0.38; P = 0.15; 6 studies; 1453 participants, low-certainty evidence). Heterogeneity between studies for cognitive outcomes in infancy and preschool age was moderate and at school age was substantial. Regarding motor function, meta-analysis of 23 studies showed that early developmental interventions may improve motor outcomes in infancy (motor scale DQ: SMD 0.12 SD, 95% CI 0.04 to 0.19; P = 0.003; 23 studies; 2737 participants, low-certainty evidence). At preschool age, the intervention probably did not improve motor outcomes (motor scale: SMD 0.08 SD, 95% CI -0.16 to 0.32; P = 0.53; 3 studies; 264 participants, moderate-certainty evidence). The evidence at school age for both continuous (motor scale: SMD -0.06 SD, 95% CI -0.31 to 0.18; P = 0.61; three studies; 265 participants, low-certainty evidence) and dichotomous outcome measures (low score on Movement Assessment Battery for Children (ABC) : RR 1.04, 95% CI 0.82 to 1.32; P = 0.74; 3 studies; 413 participants, low-certainty evidence) suggests that intervention may not improve motor outcome. The main source of bias was performance bias, where there was a lack of blinding of participants and personnel, which was unavoidable in this type of intervention study. Other biases in some studies included attrition bias where the outcome data were incomplete, and inadequate allocation concealment or selection bias. The GRADE assessment identified a lower certainty of evidence in the cognitive and motor outcomes at school age. Cognitive outcomes at preschool age demonstrated a high certainty due to more consistency and a larger treatment effect. AUTHORS' CONCLUSIONS Early developmental intervention programmes for preterm infants probably improve cognitive and motor outcomes during infancy (low-certainty evidence) while, at preschool age, intervention is shown to improve cognitive outcomes (high-certainty evidence). Considerable heterogeneity exists between studies due to variations in aspects of the intervention programmes, the population and outcome measures utilised. Further research is needed to determine which types of early developmental interventions are most effective in improving cognitive and motor outcomes, and in particular to discern whether there is a longer-term benefit from these programmes.
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Affiliation(s)
- Jane Orton
- Royal Women's Hospital, Parkville, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
| | - Lex W Doyle
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
| | - Tanya Tripathi
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
| | - Roslyn Boyd
- The University of Queensland, Brisbane, Australia
| | - Peter J Anderson
- Department of Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Alicia Spittle
- Department of Physiotherapy, University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute and the University of Melbourne, Parkville, Australia
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Yamamichi T, Imanishi Y, Sakai T, Yoshida M, Takayama K, Uga N, Umeda S, Usui N. Risk factors for and developmental relation of delayed oral nutrition in infants with congenital diaphragmatic hernia. Pediatr Surg Int 2023; 40:2. [PMID: 37991549 DOI: 10.1007/s00383-023-05595-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To identify risk factors for delayed oral nutrition in infants with a congenital diaphragmatic hernia (CDH) and its impact on developmental delay at 18 months of age. METHODS This retrospective single-center cohort study compared the clinical parameters in patients with isolated CDH born and treated at our hospital between 2006 and 2020. We evaluated clinical features significantly related to delayed oral nutrition (defined as taking ≥ 30 days from weaning from mechanical ventilation to weaning from tube feeding). RESULTS Twenty-six of the 80 cases had delayed oral nutrition. Univariate analyses showed significant differences. Multivariate analyses were performed on the three items of preterm delivery, defect size (over 50% to nearly entire defect), and ventilation for ≥ 9 days. We identified the latter two items as independent risk factors. The adjusted odds ratios were 4.65 (95% confidence interval, 1.27-7.03) and 6.02 (1.65-21.90), respectively. Delayed oral nutrition was related to a significantly higher probability of developmental delay at 18 months (crude odds ratio 4.16, 1.19-14.5). CONCLUSION In patients with CDH, a large defect and ventilatory management over 9 days are independent risk factors for delayed oral nutrition, which is a potent predictor of developmental delay that requires active developmental care.
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Affiliation(s)
- Taku Yamamichi
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan.
| | - Yousuke Imanishi
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Takaaki Sakai
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
| | - Mina Yoshida
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
| | - Keita Takayama
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
| | - Naoko Uga
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
| | - Satoshi Umeda
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
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9
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Brown RN, Burnett AC, Thompson DK, Spittle AJ, Ellis R, Cheong JLY, Doyle LW, Pascoe L, Anderson PJ. Motor performance and attention outcomes in children born very preterm. Dev Med Child Neurol 2023; 65:1501-1510. [PMID: 37060580 DOI: 10.1111/dmcn.15620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/17/2023]
Abstract
AIM To examine the relationship between motor performance and attention in children born very preterm and at term, and investigate the presence of individual profiles of motor and attention performance. METHOD Attention and motor performance at 7 and 13 years were assessed in 197 children born very preterm (52.5% male) and 69 children born at term (47.8% male) between 2001 and 2003. Linear regression models were fitted including an interaction term for birth group. Subgroups of children with similar attention and motor performance profiles were identified using latent profile analysis. RESULTS Balance was positively associated with all attention outcomes at both ages (p < 0.006). There were specific birth group interactions for aiming and catching and manual dexterity with attention at 13 years, with positive associations observed only for children born very preterm (p < 0.001). At 7 years, three profiles were observed: average attention and motor functioning; average motor functioning and low attention functioning; and low attention and motor functioning. At 13 years, two profiles of average attention and motor functioning emerged, as well as one profile of below-average attention and motor functioning. Children born very preterm were overrepresented in the lower functioning profiles (born very preterm 56%; born at term 29%). INTERPRETATION Motor functioning at age 7 years may be a useful marker of later attention skills, particularly for children born very preterm who are at greater risk of poorer long-term cognitive outcomes. WHAT THIS PAPER ADDS Balance was positively associated with attention in children born very preterm and at term. Relationships between motor performance and attention at age 13 years differed between children born very preterm and at term. Heterogeneous motor functioning and attention outcomes were noted for children born very preterm and at term. Children born very preterm were more likely to have lower attention and motor functioning profiles than children born at term. There was greater movement in motor functioning and attention profiles between the ages of 7 and 13 years in children born very preterm.
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Affiliation(s)
- Rebecca N Brown
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Alice C Burnett
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Premature Infant Follow-up Program, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Deanne K Thompson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Ellis
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Leona Pascoe
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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10
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Ehrhardt H, Aubert AM, Ådén U, Draper ES, Gudmundsdottir A, Varendi H, Weber T, Zemlin M, Maier RF, Zeitlin J. Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm. JAMA Netw Open 2023; 6:e2332413. [PMID: 37672271 PMCID: PMC10483322 DOI: 10.1001/jamanetworkopen.2023.32413] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/29/2023] [Indexed: 09/07/2023] Open
Abstract
Importance The Apgar score is used worldwide as an assessment tool to estimate the vitality of newborns in their first minutes of life. Its applicability to estimate neurodevelopmental outcomes in infants born extremely preterm (EPT; <28 weeks' gestation) is not well established. Objective To investigate the association between the Apgar score and neurodevelopmental outcomes in infants born EPT. Design, Setting, and Participants This cohort study was conducted using data from the Effective Perinatal Intensive Care in Europe-Screening to Improve Health in Very Preterm Infants in Europe (EPICE-SHIPS) study, a population-based cohort in 19 regions of 11 European countries in 2011 to 2012. Clinical assessments of cognition and motor function at age 5 years were performed in infants born EPT and analyzed in January to July 2023. Exposures Apgar score at 5 minutes of life categorized into 4 groups (0-3, 4-6, 7-8, and 9-10 points). Main Outcomes and Measures Cognitive and motor outcomes were assessed using the Wechsler Preschool and Primary Scale of Intelligence test of IQ derived from locally normed versions by country and the Movement Assessment Battery for Children-Second Edition. Parents additionally provided information on communication and problem-solving skills using the Ages and Stages Questionnaire, third edition (ASQ-3). All outcomes were measured as continuous variables. Results From the total cohort of 4395 infants born EPT, 2522 infants were live born, 1654 infants survived to age 5 years, and 996 infants (478 females [48.0%]) followed up had at least 1 of 3 outcome measures. After adjusting for sociodemographic variables, perinatal factors, and severe neonatal morbidities, there was no association of Apgar score with IQ, even for scores of 3 or less (β = -3.3; 95% CI, -10.5 to 3.8) compared with the score 9 to 10 category. Similarly, no association was found for ASQ-3 (β = -2.1; 95% CI, -24.6 to 20.4). Congruent results for Apgar scores of 3 or less were obtained for motor function scores for all children (β = -4.0; 95% CI, -20.1 to 12.1) and excluding children with a diagnosis of cerebral palsy (β = 0.8, 95% CI -11.7 to 13.3). Conclusions and Relevance This study found that low Apgar scores were not associated with longer-term outcomes in infants born EPT. This finding may be associated with high interobserver variability in Apgar scoring, reduced vitality signs and poorer responses to resuscitation after birth among infants born EPT, and the association of more deleterious exposures in the neonatal intensive care unit or of socioeconomic factors with greater changes in outcomes during the first 5 years of life.
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Affiliation(s)
- Harald Ehrhardt
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Adrien M. Aubert
- Université Paris Cité, Inserm, National Research Institute for Agriculture, Food and the Environment, Centre for Research in Epidemiology and Statistics, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Paris, France
| | - Ulrika Ådén
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth S. Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Anna Gudmundsdottir
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Heili Varendi
- University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - Tom Weber
- University of Copenhagen, Copenhagen, Denmark
| | - Michael Zemlin
- Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg, Germany
| | - Rolf F. Maier
- Children’s Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, National Research Institute for Agriculture, Food and the Environment, Centre for Research in Epidemiology and Statistics, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Paris, France
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11
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Costa R, Aubert AM, Seppänen AV, Ådén U, Sarrechia I, Zemlin M, Cuttini M, Männamaa M, Pierrat V, van Heijst A, Barros H, Zeitlin J, Johnson S. Prediction of movement difficulties at 5 years from parent report at 2 years in children born extremely preterm. Dev Med Child Neurol 2023; 65:1215-1225. [PMID: 38038478 DOI: 10.1111/dmcn.15518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/21/2022] [Indexed: 02/24/2023]
Abstract
AIM To assess the predictive validity of parent-reported gross motor impairment (GMI) at age 2 years to detect significant movement difficulties at age 5 years in children born extremely preterm. METHOD Data were from 556 children (270 males, 286 females) born at less than 28 weeks' gestation in 2011 to 2012 in 10 European countries. Parent report of moderate/severe GMI was defined as walking unsteadily or unable to walk unassisted at 2 years corrected age. Examiners assessed significant movement difficulties (score ≤ 5th centile on the Movement Assessment Battery for Children, Second Edition) and diagnoses of cerebral palsy (CP) were collected by parent report at 5 years chronological age. RESULTS At 2 years, 66 (11.9%) children had moderate/severe GMI. At 5 years, 212 (38.1%) had significant movement difficulties. Parent reports of GMI at age 2 years accurately classified CP at age 5 years in 91.0% to 93.2% of children. Classification of moderate/severe GMI at age 2 years had high specificity (96.2%; 95% confidence interval 93.6-98.0) and positive predictive value (80.3%; 68.7-89.1) for significant movement difficulties at age 5 years. However, 74.5% of children with significant movement difficulties at 5 years were not identified with moderate/severe GMI at age 2 years, resulting in low sensitivity (25.1%; 19.4-31.5). INTERPRETATION This questionnaire may be used to identify children born extremely preterm who at age 2 years have a diagnosis of CP or movement difficulties that are likely to have a significant impact on their functional outcomes at age 5 years.
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Affiliation(s)
- Raquel Costa
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Adrien M Aubert
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Anna-Veera Seppänen
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Iemke Sarrechia
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Michael Zemlin
- Saarland University Medical Center, Department für General Pediatrics and Neonatology, Homburg, Germany
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mairi Männamaa
- Department of Paediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Véronique Pierrat
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
- Erasmus MC, Rotterdam, the Netherlands
| | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Samantha Johnson
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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12
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Séassau A, Munos P, Gire C, Tosello B, Carchon I. Neonatal Care Unit Interventions on Preterm Development. CHILDREN (BASEL, SWITZERLAND) 2023; 10:999. [PMID: 37371231 PMCID: PMC10297482 DOI: 10.3390/children10060999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
Prematurity is becoming a real public health issue as more and more children are being born prematurely, alongside a higher prevalence of neurodevelopmental disorders. Early intervention programs in Neonatal Intensive Care Units (NICUs) correspond to these uni- or multi-sensorial solicitations aiming to prevent and detect complications in order to support the development of preterm infants. This article aims to distinguish sensory intervention programs according to the gradient of the type of solicitations, uni- or multi-modal, and according to the function of the person who performs these interventions. Uni-sensorial interventions are essentially based on proprioceptive, gustatory, or odorant solicitations. They allow, in particular, a reduction of apneas that support the vegetative states of the preterm infant. On the other hand, the benefits of multi-sensory interventions seem to have a longer-term impact. Most of them allow the support of the transition from passive to active feeding, an increase in weight, and the improvement of sleep-wake cycles. These solicitations are often practiced by caregivers, but the intervention of parents appears optimal since they are the main co-regulators of their preterm child's needs. Thus, it is necessary to co-construct and train the parents in this neonatal care.
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Affiliation(s)
- Alexia Séassau
- Centre Hospitalier du Pays d’Aix, 13100 Aix-en-Provence, France
| | | | - Catherine Gire
- Department of Neonatology, Hôpital Nord de Marseille, 13015 Marseille, France
| | - Barthélémy Tosello
- Department of Neonatology, Hôpital Nord de Marseille, 13015 Marseille, France
| | - Isabelle Carchon
- CHART Human and Artificial Cognition Laboratory at Ephe, École Pratique des Hautes Études-PSL Paris-Sciences-Lettres, 93322 Aubervilliers, France
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13
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Topal Y, Yardımcı-Lokmanoğlu BN, Topuz S, Mutlu A. Early spontaneous movements and spatiotemporal gait characteristics in preterm children. Eur J Pediatr 2023:10.1007/s00431-023-04949-7. [PMID: 37060442 DOI: 10.1007/s00431-023-04949-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 04/16/2023]
Abstract
This study aimed to analyze spatiotemporal gait characteristics of preterm children from 3 to 4 years of age according to different gestational age groups and to examine the relationship between the detailed general movements assessment and spatiotemporal gait characteristics. A total of 74 preterm children, 32 extremely preterm and very preterm (EP-VP, < 32 weeks gestational age) and 42 moderate to late preterm (MLP, 32 to < 37 weeks gestational age), were included in this prospective study, along with 38 term children. Early spontaneous movements of preterm children were assessed from videos at 9-20 weeks post-term according to the general movements assessment, which determines the Motor Optimality Score-Revised (MOS-R). The spatiotemporal gait characteristics of all children were evaluated using the GAITRite®electronic walkway at self-selected walking speeds. EP-VP children walked with shorter step lengths (p = 0.039), and MLP children walked with greater step length variability (p = 0.003) than their term peers. The MOS-R results were related to step length (r = 0.36, p = 0.042), step length variability (r = -0.56, p = 0.001), and base of support (r = -0.37, p = 0.038) in EP-VP children. The MOS-R subcategories, age-adequate movement repertoire, and postural patterns were related to some of the spatiotemporal gait characteristics, including step length, step length variability, and base of support (p < 0.05). Conclusion: EP-VP and MLP children might catch up to their term peers at 3 to 4 years of age in terms of most gait parameters. In addition to the MOS-R, age-adequate movement repertoire and postural patterns of preterm children without cerebral palsy in early life may be a marker of later neurodevelopmental dysfunction. What is Known: • Preterm children walk with a wider step width, a greater step length asymmetry and step time, and a shorter stride length at 18 to 22 months of age compared with term children at a self-selected speed, while these differences disappear in children 4.5-5 years old and older. What is New: • Early spontaneous movements were related to some spatiotemporal gait characteristics. • Preterm children might catch up to term children at 3-4 years of age in spatiotemporal gait characteristics while walking at a self-selected speed.
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Affiliation(s)
- Yusuf Topal
- Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye.
| | - Bilge Nur Yardımcı-Lokmanoğlu
- Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Semra Topuz
- Gait Analysis Laboratory, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Akmer Mutlu
- Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
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14
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Montgomery C, Setänen S, Kaul YF, Farooqi A, Broström L, Aden U, Källén K, Serenius F. Predictive value of Bayley-III Motor Index for later motor difficulties in children born extremely preterm. Acta Paediatr 2023; 112:742-752. [PMID: 36723223 DOI: 10.1111/apa.16694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/21/2022] [Accepted: 01/30/2023] [Indexed: 02/02/2023]
Abstract
AIM To investigate the predictive ability of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) Motor Index, in children born extremely preterm (<27 gestational weeks) without cerebral palsy. METHODS Children from the EXPRESS study (all extremely preterm births in Sweden, 2004-2007) without neurosensory impairments assessed with Bayley-III at 2.5 years corrected age and Movement Assessment Battery for Children, Second Edition (MABC-2), at 6.5 years comprised the eligible study population (n = 282). Motor difficulty was defined as MABC-2 ≤5th percentile. RESULTS Motor difficulties were found in 57 of 282 children (20.2%) at 6.5 years. The Bayley-III explained 18.0% of the variance in the MABC-2 (p < 0.001). The area under the receiver operating curve was 0.71 (95% confidence interval 0.64-0.79, p < 0.001). At a Bayley-III cut-off value of 85, sensitivity, specificity and positive and negative predictive values for motor difficulties were 26.3% (15.5-39.7), 92.9% (88.1-95.9), 48.4% (33.0-64.0) and 83.3% (80.9-85.4). Likelihood ratios were inconclusive. CONCLUSION The Bayley-III at 2.5 years corrected age was a modest predictor of motor outcome in children born extremely preterm at 6.5 years, and underestimated the rate of motor difficulties. Children require follow-up beyond preschool age.
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Affiliation(s)
- Cecilia Montgomery
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sirkku Setänen
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Aijaz Farooqi
- Department of Neonatology: Child and Adolescent Medicine, Umeå University Hospital, Umeå, Sweden
| | - Lina Broström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Aden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Obstetrics and Gynecology, Lund University, Lund, Sweden
| | - Fredrik Serenius
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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15
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Long-term outcomes of preterm infants in the first 6 years of life: a nationwide population-based study in Korea. Eur J Pediatr 2023; 182:641-650. [PMID: 36445516 DOI: 10.1007/s00431-022-04728-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Abstract
UNLABELLED This study examined the relationship between gestational age and long-term outcomes up to 6 years of age using population-based big data from the National Health Insurance Service in Korea. This retrospective observational cohort study used data from the National Health Information Database (2011-2017). All children born in Korea during 2011 (January 1-December 31) were eligible and were followed up until 2017. Gestational age groups were divided into extremely preterm (< 28 weeks), very preterm (28-31 weeks), moderate-to-late preterm (32-36 weeks), and full-term (37-41 weeks). The survival rate, neurodevelopmental diseases, hearing or visual impairment, and respiratory morbidities were compared for each gestational age group. In total, 370,301 children were included in the analysis. The total survival rate increased with increasing gestational age. Furthermore, the risk of neurodevelopmental diseases (i.e., epilepsy, cerebral palsy, delayed development, mental retardation, language disorder, developmental coordination disorder, autism spectrum disorder), hearing or visual impairment, and asthma-related inhaler prescription increased with decreasing gestational age, despite adjustment for covariates. CONCLUSION Lower gestational age was associated with an increase in a wide spectrum of adverse neurodevelopmental and respiratory outcomes in the first 6 years of life. Although morbidities were highest at the earliest gestational ages, moderate-to-late preterm children were significantly associated with increased adverse outcomes compared with full-term children. Our findings prove this under-recognized group's long-term follow-up and policy support. WHAT IS KNOWN • Infants born preterm are at high risk for neurodevelopmental and various medical health problems. • Nationwide research on long-term outcomes for moderate-to-late preterm birth is sparse. WHAT IS NEW • In this nationwide cohort study, lower gestational age at birth was inversely associated with increased adverse neurodevelopmental and respiratory outcomes in the first 6 years of life. • Long-term follow-up and policy support are required for moderate-to-late preterm children who are at risk of increased adverse outcomes compared with full-term births.
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16
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Risk factors for cerebral palsy and movement difficulties in 5-year-old children born extremely preterm. Pediatr Res 2023:10.1038/s41390-022-02437-6. [PMID: 36694025 DOI: 10.1038/s41390-022-02437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/10/2022] [Accepted: 11/19/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Motor impairment is common after extremely preterm (EPT, <28 weeks' gestational age (GA)) birth, with cerebral palsy (CP) affecting about 10% of children and non-CP movement difficulties (MD) up to 50%. This study investigated the sociodemographic, perinatal and neonatal risk factors for CP and non-CP MD. METHODS Data come from a European population-based cohort of children born EPT in 2011-2012 in 11 countries. We used multinomial logistic regression to assess risk factors for CP and non-CP MD (Movement Assessment Battery for Children - 2nd edition ≤5th percentile) compared to no MD (>15th percentile) among 5-year-old children. RESULTS Compared to children without MD (n = 366), young maternal age, male sex and bronchopulmonary dysplasia were similarly associated with CP (n = 100) and non-CP MD (n = 224) with relative risk ratios (RRR) ranging from 2.3 to 3.6. CP was strongly related to severe brain lesions (RRR >10), other neonatal morbidities, congenital anomalies and low Apgar score (RRR: 2.4-3.3), while non-CP MD was associated with primiparity, maternal education, small for GA (RRR: 1.6-2.6) and severe brain lesions, but at a much lower order of magnitude. CONCLUSION CP and non-CP MD have different risk factor profiles, with fewer clinical but more sociodemographic risk factors for non-CP MD. IMPACT Young maternal age, male sex and bronchopulmonary dysplasia similarly increased risks of both cerebral palsy and non-cerebral palsy movement difficulties. Cerebral palsy was strongly related to clinical risk factors including severe brain lesions and other neonatal morbidities, while non-cerebral palsy movement difficulties were more associated with sociodemographic risk factors. These results on the similarities and differences in risk profiles of children with cerebral palsy and non-cerebral palsy movement difficulties raise questions for etiological research and provide a basis for improving the identification of children who may benefit from follow-up and early intervention.
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17
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Danks M, Flynn EJ, Gray PH, Hurrion EM. 'Low-normal' motor skills in infants at high risk for poor developmental outcomes: A prevalence and prognostic study. Dev Med Child Neurol 2022; 64:1517-1523. [PMID: 35598100 DOI: 10.1111/dmcn.15267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 01/31/2023]
Abstract
AIM To investigate the prevalence and prognostic value of 'low-normal' motor skills in infants at high-risk for poor developmental outcomes. METHOD Infants born extremely low-birthweight and extremely preterm discharged from neonatal intensive care between 2015 and 2018 completed the Alberta Infant Motor Scale (AIMS), Neuro-Sensory Motor Developmental Assessment (NSMDA) at corrected age 4, 8, and 12 months, and Griffiths Mental Development Scale at corrected age 12 months. RESULTS Participating infants (n = 191) with a mean gestational age (95% confidence interval [CI]) of 26.80 weeks (26.60, 27.1) and mean birthweight (95% CI) of 869 grams (843, 895) included 45 (23.80%) infants small for gestational age. AIMS rated 50.32%, 35.37%, and 14.86% of infants within the 'low-normal' motor skills range (1-2 SD below the mean for age) at 4, 8, and 12 months respectively. Of the infants within the AIMS 'low-normal' skills range, 55.70%, 88.46%, and 59.10% were classified as having impairment by NSMDA at 4, 8, and 12 months respectively. Griffiths assessment at 12 months identified only 7.33% of infants with 'low-normal' skills and 3.33% with motor disability. Minimal motor impairment rating on the NSMDA at 4 or 8 months significantly predicted general development at 12 months. INTERPRETATION High-risk infants with 'low-normal' motor skills may warrant referral to early intervention as associated impairment represents increased risk for poorer general development outcomes. WHAT THIS PAPER ADDS High prevalence of 'low-normal' motor skill exists in high-risk infants. Clinical motor assessment validly identifies infants with motor impairment. Minimal motor impairment in high-risk infants is prognostic of general development. High-risk infants with 'low-normal' motor skills may warrant early intervention. Griffiths Scales of Child Development, Third Edition assessment at 12-months age may under-identify motor difficulties.
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Affiliation(s)
- Marcella Danks
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Emma J Flynn
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Peter H Gray
- Mater Research Institute-The University of Queensland, Brisbane, Australia
| | - Elizabeth M Hurrion
- Mater Research Institute-The University of Queensland, Brisbane, Australia.,Department of Newborn Services, Mater Mothers' Hospital, Brisbane, Australia
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18
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Neumane S, Gondova A, Leprince Y, Hertz-Pannier L, Arichi T, Dubois J. Early structural connectivity within the sensorimotor network: Deviations related to prematurity and association to neurodevelopmental outcome. Front Neurosci 2022; 16:932386. [PMID: 36507362 PMCID: PMC9732267 DOI: 10.3389/fnins.2022.932386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
Consisting of distributed and interconnected structures that interact through cortico-cortical connections and cortico-subcortical loops, the sensorimotor (SM) network undergoes rapid maturation during the perinatal period and is thus particularly vulnerable to preterm birth. However, the impact of prematurity on the development and integrity of the emerging SM connections and their relationship to later motor and global impairments are still poorly understood. In this study we aimed to explore to which extent the early microstructural maturation of SM white matter (WM) connections at term-equivalent age (TEA) is modulated by prematurity and related with neurodevelopmental outcome at 18 months corrected age. We analyzed 118 diffusion MRI datasets from the developing Human Connectome Project (dHCP) database: 59 preterm (PT) low-risk infants scanned near TEA and a control group of full-term (FT) neonates paired for age at MRI and sex. We delineated WM connections between the primary SM cortices (S1, M1 and paracentral region) and subcortical structures using probabilistic tractography, and evaluated their microstructure with diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) models. To go beyond tract-specific univariate analyses, we computed a maturational distance related to prematurity based on the multi-parametric Mahalanobis distance of each PT infant relative to the FT group. Our results confirmed the presence of microstructural differences in SM tracts between PT and FT infants, with effects increasing with lower gestational age at birth. Maturational distance analyses highlighted that prematurity has a differential effect on SM tracts with higher distances and thus impact on (i) cortico-cortical than cortico-subcortical connections; (ii) projections involving S1 than M1 and paracentral region; and (iii) the most rostral cortico-subcortical tracts, involving the lenticular nucleus. These different alterations at TEA suggested that vulnerability follows a specific pattern coherent with the established WM caudo-rostral progression of maturation. Finally, we highlighted some relationships between NODDI-derived maturational distances of specific tracts and fine motor and cognitive outcomes at 18 months. As a whole, our results expand understanding of the significant impact of premature birth and early alterations on the emerging SM network even in low-risk infants, with possible relationship with neurodevelopmental outcomes. This encourages further exploration of these potential neuroimaging markers for prediction of neurodevelopmental disorders, with special interest for subtle neuromotor impairments frequently observed in preterm-born children.
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Affiliation(s)
- Sara Neumane
- Inserm, NeuroDiderot, Université Paris Cité, Paris, France
- CEA, NeuroSpin UNIACT, Université Paris-Saclay, Paris, France
- School of Biomedical Engineering and Imaging Sciences, Centre for the Developing Brain, King’s College London, London, United Kingdom
| | - Andrea Gondova
- Inserm, NeuroDiderot, Université Paris Cité, Paris, France
- CEA, NeuroSpin UNIACT, Université Paris-Saclay, Paris, France
| | - Yann Leprince
- CEA, NeuroSpin UNIACT, Université Paris-Saclay, Paris, France
| | - Lucie Hertz-Pannier
- Inserm, NeuroDiderot, Université Paris Cité, Paris, France
- CEA, NeuroSpin UNIACT, Université Paris-Saclay, Paris, France
| | - Tomoki Arichi
- School of Biomedical Engineering and Imaging Sciences, Centre for the Developing Brain, King’s College London, London, United Kingdom
- Paediatric Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jessica Dubois
- Inserm, NeuroDiderot, Université Paris Cité, Paris, France
- CEA, NeuroSpin UNIACT, Université Paris-Saclay, Paris, France
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19
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Lima CRG, Abreu RWFD, Verdério BN, Brugnaro BH, Santos MMD, Dos Santos AN, Morgan C, Rocha NACF. Early Intervention Involving Specific Task-Environment-Participation (STEP) Protocol for Infants at Risk: A Feasibility Study. Phys Occup Ther Pediatr 2022; 43:303-320. [PMID: 36329671 DOI: 10.1080/01942638.2022.2142084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aims: To verify the feasibility and preliminary effects of the STEP protocol, an intervention based on specific motor skills, environmental factors and participation, in infants at biological risk.Methods: Twenty-eight at-risk infants (STEP Protocol = 14; Standard Intervention = 14), aged 3-9 months and at risk for developmental delay. The following outcomes were assessed: motor skills (Alberta Infant Motor Scale-AIMS); frequency and involvement of participation (Young Children's Participation and Environment Measure-YC-PEM), and home environment opportunities (Affordances in the Home Environment for Motor Development-AHEMD-IS). For both groups, interventions were provided by parents. The intervention for group was based on the following principles: (1) standard intervention: stimulation of motor skills; (2) STEP: stimulation of motor skills, participation, mother-infant interaction, environmental enrichment. A mean comparison test was applied to verify difference between groups after the intervention.Results: The protocol showed good retention and recruitment rates. The STEP group had significantly higher outcomes after intervention on the AIMS (p = 0.014); frequency (p = 0.02) and engagement (p = 0.03) in participation, when compared to standard intervention.Conclusions: The results showed that the STEP protocol is feasible, and presents better results compared to the standard intervention, which reinforces the importance of promoting participation, specific motor skills and family involvement.
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Affiliation(s)
- Camila Resende Gâmbaro Lima
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, São Carlos-SP, Brazil
| | | | - Bruna Nayara Verdério
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, São Carlos-SP, Brazil
| | - Beatriz Helena Brugnaro
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, São Carlos-SP, Brazil
| | - Mariana Martins Dos Santos
- Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, São Carlos-SP, Brazil
| | | | - Catherine Morgan
- School of Medicine, Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
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20
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Bando N, Walton K, O'Connor DL, Janus M, Unger SL. Examination of school readiness and factors related to developmental vulnerability in children born very low birth weight. Child Care Health Dev 2022; 49:444-455. [PMID: 36070087 DOI: 10.1111/cch.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 08/02/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many children born very low birth weight (VLBW) experience school struggles with preparedness requiring adequate physical, social, behavioural, cognitive and communication skills. A global assessment of proficiency is necessary to identify those at risk in any such area and direct early intervention accordingly. Study objectives were to characterize developmental vulnerability and school readiness scores in these key domains in a sample of children born VLBW versus their provincial public school system peers and identify early-life infant and parent factors related to suboptimal school readiness. METHODS The Early Development Instrument teacher assessments of school readiness were collected for a Canadian VLBW sample (NCT02759809). Comparisons between children born VLBW and peers were made. Group differences between children born VLBW considered vulnerable (<10th percentile, not developmentally ready for learning) and not vulnerable were tested and linear regression explored associations between early-life factors and domain scores. RESULTS Of 77 available Early Development Instrument assessments, median (interquartile range) assessment age was 6.0 (5.7, 6.2) years, birth weight 950 (793, 1250) grammes and birth gestation 27.4 (25.6, 29.7) weeks. A higher proportion of children born VLBW versus peers exhibited vulnerability in Physical Health and Well-being (24.7% vs. 16.1%, p = 0.04), Communication Skills and General Knowledge (23.4% vs. 10.2%, p = 0.0001) and vulnerability in ≥2 domains (26.0% vs. 14.4%, p = 0.004). Children born VLBW classified as vulnerable versus not vulnerable had lower birth gestation and 5-min Apgar. Adjusted regression models found Apgar <7 associated with lower scores for Physical Health and Well-being (-0.86; 95%CI: -1.71, -0.00; p = 0.049), Social Competence (-1.77; 95%CI: -2.92, -0.62; p = 0.003), Emotional Maturity (-1.55; 95%CI: -2.43, -0.66; p = 0.0009) and Communication Skills and General Knowledge (-1.63; 95%CI: -3.19, -0.06; p = 0.04). CONCLUSIONS This VLBW sample exhibited poor school readiness in multiple domains. Identification of lower birth gestation and Apgar may assist targeted early interventions to mitigate vulnerability.
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Affiliation(s)
- Nicole Bando
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn Walton
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Paediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Magdalena Janus
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sharon L Unger
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Paediatrics, Sinai Health, Toronto, Ontario, Canada.,Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Paediatrics, University of Toronto, Toronto, Ontario, Canada
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21
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Costa R, Aubert AM, Seppänen AV, Ådén U, Sarrechia L, Zemlin M, Cuttini M, Männamaa M, Pierrat V, van Heijst A, Barros H, Johnson S, Zeitlin J. Motor-related health care for 5-year-old children born extremely preterm with movement impairments. Dev Med Child Neurol 2022; 64:1131-1144. [PMID: 35298035 DOI: 10.1111/dmcn.15202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 01/24/2023]
Abstract
AIM To (1) determine the proportion of 5-year-old children born extremely preterm (EPT) with movement difficulties including cerebral palsy (CP) and the proportion of these children receiving motor-related health care (MRHC), and (2) describe factors associated with receiving MRHC. METHOD Children born before 28 weeks' gestation in 2011 to 2012 in 11 European countries were assessed with the Movement Assessment Battery for Children, Second Edition (MABC-2) at 5 years of age. Information on family characteristics, child health including CP diagnosis, and health care use were collected using parent-report questionnaires. MRHC was defined as visits in the previous year with health care providers (physical and occupational therapists) specialized in assessing/treating motor problems. We analysed receipt of MRHC and associated factors among children at risk of movement difficulties (MABC-2 score 6th-15th centiles), with significant movement difficulties (SMD; ≤5th centile) or with CP. RESULTS Of 807 children assessed at 5 years 7 months (SD 4 months; 4 years 7 months-7 years 1 month), 412 were males (51.1%), 170 (21.1%) were at risk of movement difficulties, 201 (24.9%) had SMD, and 92 (11.4%) had CP. Those who received MRHC comprised 89.1% of children with CP, 42.8% with SMD, and 25.9% at risk of movement difficulties. MRHC for children with SMD varied from 23.3% to 66.7% between countries. Children were more likely to receive MRHC if they had other developmental problems or socioemotional, conduct, or attention difficulties. INTERPRETATION Efforts are needed to increase MRHC for 5-year-old children born EPT with movement difficulties. WHAT THIS PAPER ADDS Children born extremely preterm without cerebral palsy frequently experienced motor difficulties. Most of these children were not receiving motor-related health care (MRHC). Large geographical differences throughout Europe were observed in receipt of MRHC. Socioemotional problems were related to MRHC use.
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Affiliation(s)
- Raquel Costa
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Adrien M Aubert
- Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRAE, Université de Paris Cité, Paris, France
| | - Anna-Veera Seppänen
- Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRAE, Université de Paris Cité, Paris, France
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Lemke Sarrechia
- Department of Medicine & Population Health, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Michael Zemlin
- Department of Medicine, University of Saarland, Saarland, Germany
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mairi Männamaa
- Department of Paediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Véronique Pierrat
- Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRAE, Université de Paris Cité, Paris, France.,Department of Neonatal Medicine, CHU Lille, Jeanne de Flandre Hospital, Lille, France
| | - Arno van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jennifer Zeitlin
- Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRAE, Université de Paris Cité, Paris, France
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22
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A Bibliometric and Visualization Analysis of Motor Learning in Preschoolers and Children over the Last 15 Years. Healthcare (Basel) 2022; 10:healthcare10081415. [PMID: 36011071 PMCID: PMC9407894 DOI: 10.3390/healthcare10081415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
Motor learning enables preschoolers and children to acquire fundamental skills that are critical to their development. The current study sought to conduct a bibliometric and visualization analysis to provide a comprehensive overview of motor-learning progress in preschoolers and children over the previous 15 years. The number of studies is constantly growing, with the United States and Australia, as well as other productive institutions and authors, at the leading edge. The dominant disciplines were Neurosciences and Neurology, Psychology, Rehabilitation, and Sport Sciences. The journals Developmental Medicine & Child Neurology, Human Movement Science, Physical Therapy, Neuropsychology, Journal of Motor Behavior, and Journal of Experimental Child Psychology have been the most productive and influential in this regard. The most common co-citations for clinical symptoms were for cerebral palsy, developmental coordination disorder, and autism. Research has focused on language impairment (speech disorders, explicit learning, and instructor-control feedback), as well as effective intervention strategies. Advances in brain mechanisms and diagnostic indicators, as well as new intervention and rehabilitation technologies (virtual reality, transcranial magnetic stimulation, and transcranial direct current stimulation), have shifted research frontiers and progress. The cognitive process is critical in intervention, rehabilitation, and new technology implementation and should not be overlooked. Overall, our broad overview identifies three major areas: brain mechanism research, clinical practice (intervention and rehabilitation), and new technology application.
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23
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The trajectory of general movements from birth until 12 - 14 weeks corrected age in very low birthweight and extremely low-birthweight infants born preterm. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i2.1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. General movement assessment (GMA) is an assessment tool with high predictive validity for neurodevelopmental outcomes in preterm infants. Information available describing the trajectory of general movements (GMs) in high-risk preterm-born infants and the use thereof in low- and middle-income countries is limited.
Objective. To describe the trajectories of GMs from birth until 12 - 14 weeks’ corrected age, and determine the association of known perinatal risk factors on GM trajectories in very low-birthweight and extremely low-birthweight preterm infants.
Methods. This was a longitudinal, prospective cohort study with 119 preterm infants born at <33 weeks’ gestation and with a birthweight <1 500 g. GMs were recorded at four key age periods: 1 - 2 weeks after birth to 33 weeks post menstrual age (PMA); 34 - 37 weeks PMA; term equivalent age (TEA); and 12 - 14 weeks corrected age. Detailed perinatal data were collected.
Results. A total of 300 GMAs were conducted, 157 during the preterm age, 55 during TEA and 88 at 12 - 14 weeks corrected age. At <33 weeks PMA, 96% of GMs were abnormal and 4% normal. At 34 - 37 weeks PMA, 89% of GMs were abnormal and 11% normal. All GMs recorded at term equivalent age were abnormal. At 12 - 14 weeks corrected age, 7% of GMs were abnormal and 93% normal.
Conclusion. GMs were predominantly abnormal prior to term with a significant decrease in abnormality at 12 - 14 weeks corrected age. Lower birthweight and lower PMA were associated with increased odds for abnormal GMs. In a resource-constrained environment, observing GMs at 12 - 14 weeks corrected age (during the fidgety period) is a time- and cost-effective method to determine the risk for adverse neurodevelopment.
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24
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Stedall PM, Spencer-Smith MM, Mainzer RM, Treyvaud K, Burnett AC, Doyle LW, Spittle AJ, Anderson PJ. Thirteen-Year Outcomes of a Randomized Clinical Trial of Early Preventive Care for Very Preterm Infants and Their Parents. J Pediatr 2022; 246:80-88.e4. [PMID: 35304169 DOI: 10.1016/j.jpeds.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate 13-year outcomes of a randomized controlled trial of preventive care (VIBeS Plus) for infants born very preterm and their parents and examine whether possible effects of intervention varied by family social risk. STUDY DESIGN Families were randomized to an intervention arm (n = 61) or a standard care arm (n = 59). The intervention was delivered at home by psychologists and physiotherapists over the infants' first year, focusing on infant development and parental mental health. At 13 years corrected age, cognitive, motor, and behavioral outcomes, and parental mental health were assessed. Primary estimands were between-group mean differences, estimated using multiple imputed regression models. RESULTS Follow-up included 81 surviving children (69%). There was little evidence of benefits of the intervention for IQ, attention, executive functioning, working memory, and academic skills regardless of level of social risk. Specifically, mean differences in adolescent cognitive outcomes ranged from -2.0 units (95% CI, -9.9 to 5.9) in favor of standard treatment to 5.1 units (95% CI, -2.3 to 12.5) favoring the intervention. A group-by-social risk interaction was observed only for adolescent motor outcomes, with mean differences favoring the intervention for those at higher social risk (balance, 4.9; 95% CI, 1.3-8.5; total motor, 3.2; 95% CI, 0.3-6.2), but not those at lower social risk (balance, -0.3; 95% CI, -2.4 to 1.9; total motor, 0.03; 95% CI, -1.9 to 2.0). Mean differences in adolescent behavior and parental mental health ranged from -6.6 (95% CI -13.8, 0.5) to -0.2 (95% CI, -1.9 to 1.4) and -1.8 (95% CI, -4.1 to 0.6) to -1.7 (95% CI, -4.3 to 1.0), respectively, indicating a pattern of fewer symptoms in the intervention group. CONCLUSIONS Benefits of the intervention persisted for adolescent behavior, with better motor outcomes observed in those from socially disadvantaged families. Replication with larger samples, multiple informant reports, and assessment of quality of life-related outcomes is warranted. TRIAL REGISTRATION http://www.anzctr.org.au/: ACTRN12605000492651.
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Affiliation(s)
- Paulina M Stedall
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Megan M Spencer-Smith
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Rheanna M Mainzer
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Karli Treyvaud
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Alice C Burnett
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Premature Infant Follow-up Program, Royal Women's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neonatal Medicine, Royal Children's Hospital, Parkville, Australia
| | - Lex W Doyle
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Premature Infant Follow-up Program, Royal Women's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
| | - Alicia J Spittle
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Research, Royal Women's Hospital, Parkville, Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
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25
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Spittle AJ, Olsen JE, FitzGerald TL, Cameron KL, Albesher RA, Mentiplay BF, Treyvaud K, Burnett A, Lee KJ, Pascoe L, Roberts G, Doyle LW, Anderson P, Cheong JLY. School Readiness in Children Born <30 Weeks' Gestation at Risk for Developmental Coordination Disorder: A Prospective Cohort Study. J Dev Behav Pediatr 2022; 43:e312-e319. [PMID: 34723933 DOI: 10.1097/dbp.0000000000001031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether school readiness differs between children born <30 weeks' gestation who are classified as at risk for developmental coordination disorder (DCD) and those who are not. METHODS This study was a prospective cohort study of children born <30 weeks' gestation. Children were classified as at risk for DCD at a corrected age of 4 to 5 years if they scored <16th centile on the Movement Assessment Battery for Children-Second Edition (MABC-2), had a full scale IQ score of ≥80 on the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV), and had no cerebral palsy. Children were assessed on 4 school readiness domains: (1) health/physical development [Physical Health domain of Pediatric Quality of Life Inventory (PedsQL), Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and Little Developmental Coordination Disorder Questionnaire], (2) social-emotional development (Strengths and Difficulties Questionnaire and PedsQL psychosocial domains), (3) cognitive skills/general knowledge (WPPSI-IV), and (4) language skills (WPPSI-IV). RESULTS Of 123 children assessed, 16 were ineligible (IQ < 80 or cerebral palsy: n = 15; incomplete MABC-2: n = 1); 28 of 107 (26%) eligible children were at risk for DCD. Children at risk for DCD had poorer performance on all school readiness domains, with group differences of more than 0.4 SD in health/physical development, social-emotional development, and language skills and up to 0.8 SD for cognitive skills/general knowledge compared with those not at risk of DCD. CONCLUSION Being at risk for DCD in children born <30 weeks' gestation is associated with challenges in multiple school readiness domains, not only the health/physical domain.
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Affiliation(s)
- Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia
| | - Joy E Olsen
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia
| | - Tara L FitzGerald
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Kate L Cameron
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Reem A Albesher
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Benjamin F Mentiplay
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Karli Treyvaud
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Alice Burnett
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katherine J Lee
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Leona Pascoe
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Gehan Roberts
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Peter Anderson
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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26
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Lin L, Gamble GD, Crowther CA, Bloomfield FH, Agosti M, Atkinson SA, Biasini A, Embleton ND, Fewtrell MS, Lamy-Filho F, Fusch C, Gianni ML, Kanmaz Kutman HG, Koo W, Litmanovitz I, Morgan C, Mukhopadhyay K, Neri E, Picaud JC, Rochow N, Roggero P, Singhal A, Stroemmen K, Tan MJ, Tandoi FM, Wood CL, Zachariassen G, Harding JE. Sex-Specific Effects of Nutritional Supplements for Infants Born Early or Small: An Individual Participant Data Meta-Analysis (ESSENCE IPD-MA) I-Cognitive Function and Metabolic Risk. Nutrients 2022; 14:418. [PMID: 35276786 PMCID: PMC8838132 DOI: 10.3390/nu14030418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 02/04/2023] Open
Abstract
Neonatal nutritional supplements are widely used to improve growth and development but may increase risk of later metabolic disease, and effects may differ by sex. We assessed effects of supplements on later development and metabolism. We searched databases and clinical trials registers up to April 2019. Participant-level data from randomised trials were included if the intention was to increase macronutrient intake to improve growth or development of infants born preterm or small-for-gestational-age. Co-primary outcomes were cognitive impairment and metabolic risk. Supplementation did not alter cognitive impairment in toddlers (13 trials, n = 1410; adjusted relative risk (aRR) 0.88 [95% CI 0.68, 1.13]; p = 0.31) or older ages, nor alter metabolic risk beyond 3 years (5 trials, n = 438; aRR 0.94 [0.76, 1.17]; p = 0.59). However, supplementation reduced motor impairment in toddlers (13 trials, n = 1406; aRR 0.76 [0.60, 0.97]; p = 0.03), and improved motor scores overall (13 trials, n = 1406; adjusted mean difference 1.57 [0.14, 2.99]; p = 0.03) and in girls not boys (p = 0.03 for interaction). Supplementation lowered triglyceride concentrations but did not affect other metabolic outcomes (high-density and low-density lipoproteins, cholesterol, fasting glucose, blood pressure, body mass index). Macronutrient supplementation for infants born small may not alter later cognitive function or metabolic risk, but may improve early motor function, especially for girls.
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Affiliation(s)
- Luling Lin
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Greg D. Gamble
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Caroline A. Crowther
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Frank H. Bloomfield
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
| | - Massimo Agosti
- Neonatal Intensive Care Unit, Woman and Child Department, Ospedale Del Ponte, Insubria University, 21100 Varese, Italy; (M.A.); (F.M.T.)
| | - Stephanie A. Atkinson
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada; (S.A.A.); (C.F.); (N.R.)
| | - Augusto Biasini
- Donor Human Milk Bank Italian Association (AIBLUD), 20126 Milan, Italy;
| | - Nicholas D. Embleton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Mary S. Fewtrell
- Childhood Nutrition Research Centre, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK;
| | - Fernando Lamy-Filho
- Departamento de Medicina, Universidade Federal do Maranhão (UFMA), São Luís 65080-805, MA, Brazil;
| | - Christoph Fusch
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada; (S.A.A.); (C.F.); (N.R.)
- Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Maria L. Gianni
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy; (M.L.G.); (P.R.)
- Department of Clinical Sciences and Community Health, University of Milan, Via Commenda 19, 20122 Milan, Italy
| | | | - Winston Koo
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA;
| | - Ita Litmanovitz
- Department of Neonatology, Meir Medical Center, Kfar Saba 44281, Israel;
| | - Colin Morgan
- Department of Neonatology, Liverpool Women’s Hospital, Liverpool L8 7SS, UK;
| | - Kanya Mukhopadhyay
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India;
| | - Erica Neri
- Department of Psychology, University of Bologna, 40100 Bologna, Italy;
| | - Jean-Charles Picaud
- Division of Neonatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France;
- CarMen Laboratory, INSERM, INRA, Claude Bernard University Lyon 1, 69677 Pierre Benite, France
| | - Niels Rochow
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada; (S.A.A.); (C.F.); (N.R.)
- Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Paola Roggero
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy; (M.L.G.); (P.R.)
| | - Atul Singhal
- Department of Nutrition, Institute of Child Health, London WC1N 1EH, UK;
| | - Kenneth Stroemmen
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, 0310 Oslo, Norway;
| | - Maw J. Tan
- Department of Developmental Paediatrics, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK;
| | - Francesco M. Tandoi
- Neonatal Intensive Care Unit, Woman and Child Department, Ospedale Del Ponte, Insubria University, 21100 Varese, Italy; (M.A.); (F.M.T.)
| | - Claire L. Wood
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Gitte Zachariassen
- H.C. Andersen Children’s Hospital, Odense University Hospital and University of Southern Denmark, 5000 Odense, Denmark;
| | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand; (L.L.); (G.D.G.); (C.A.C.); (F.H.B.)
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Olsen JE, Lee KJ, Spittle AJ, Anderson PJ, Doyle LW, Cheong JLY. The causal effect of being born extremely preterm or extremely low birthweight on neurodevelopment and social-emotional development at 2 years. Acta Paediatr 2022; 111:107-114. [PMID: 34494301 DOI: 10.1111/apa.16098] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/22/2022]
Abstract
AIM To assess the causal effect of being born extremely preterm (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g), compared with being born at term, on neurodevelopment and social-emotional development at 2 years' corrected age. METHODS Prospective geographical cohort study of children born EP/ELBW over 12 months in 2016 from Victoria, Australia, and term-born controls. Children were assessed at 2 years' corrected age with the Bayley Scales of Infant and Toddler Development-3rd edition and the Infant-Toddler Social and Emotional Assessment. Delay was defined as <-1 standard deviation relative to the mean of controls. The estimand of interest was the mean difference/odds ratio (OR) between the EP/ELBW and control groups estimated using linear/logistic regression, adjusted for multiple pregnancy and social risk. RESULTS A total of 205 EP/ELBW and 201 controls were assessed at 2 years. Delay/concerns were more common in the EP/ELBW group compared with controls, for cognitive (OR 3.7 [95% confidence interval 2.3, 6.0]), language (5.3 [3.1, 9.0]) and motor (3.9 [2.3, 6.3]) development, and social-emotional competence (4.1 [1.6, 10.2]). CONCLUSION Being born EP/ELBW has an adverse effect on cognitive, language and motor development, and social-emotional competence at 2 years' corrected age. Close developmental surveillance, including social-emotional development, is recommended.
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Affiliation(s)
- Joy E. Olsen
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
| | - Katherine J. Lee
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
| | - Alicia J. Spittle
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Physiotherapy The University of Melbourne Melbourne Victoria Australia
| | - Peter J. Anderson
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Turner Institute for Brain and Mental Health & School of Psychological Sciences Monash University Melbourne Victoria Australia
| | - Lex W. Doyle
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Department of Obstetrics and Gynaecology The University of Melbourne Melbourne Victoria Australia
| | - Jeanie L. Y. Cheong
- Murdoch Children's Research Institute Melbourne Victoria Australia
- Neonatal Services Royal Women's Hospital Melbourne Victoria Australia
- Department of Obstetrics and Gynaecology The University of Melbourne Melbourne Victoria Australia
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28
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Cameron KL, FitzGerald TL, McGinley JL, Allison K, Cheong JLY, Spittle AJ. Motor outcomes of children born extremely preterm; from early childhood to adolescence. Semin Perinatol 2021; 45:151481. [PMID: 34454740 DOI: 10.1016/j.semperi.2021.151481] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Children and adolescents born extremely preterm (EP; <28 weeks' gestation) are at greater risk of motor impairment, including cerebral palsy and developmental coordination disorder, than their term born peers. Importantly, motor impairment has implications beyond performing motor skills; it negatively affects outcomes as diverse as school success, emotional wellbeing, physical health, and physical activity (PA) participation. This review will outline what is known about PA participation across childhood and adolescence for children born EP and term, recognising that PA may improve physical, social, and mental health outcomes. Critically, PA participation occurs in the context of children's and adolescents' daily lives, and is influenced by the family, social and physical environment, as well as by the child's personal factors, such as motor impairment. Further research is needed to better understand PA participation levels and correlates for children and adolescents born preterm, to better inform effective and sustainable interventions.
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Affiliation(s)
- Kate L Cameron
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Australia.
| | - Tara L FitzGerald
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Australia; Neonatal Services, Royal Women's Hospital, Melbourne, Australia
| | - Jennifer L McGinley
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - Kim Allison
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Neonatal Services, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics & Gynaecology, University of Melbourne, The Royal Women's Hospital, Melbourne, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia; Department of Physiotherapy, University of Melbourne, Melbourne, Australia; Neonatal Services, Royal Women's Hospital, Melbourne, Australia
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Hua J, Barnett AL, Williams GJ, Dai X, Sun Y, Li H, Chen G, Wang L, Feng J, Liu Y, Zhang L, Zhu L, Weng T, Guan H, Gu Y, Zhou Y, Butcher A, Du W. Association of Gestational Age at Birth With Subsequent Suspected Developmental Coordination Disorder in Early Childhood in China. JAMA Netw Open 2021; 4:e2137581. [PMID: 34905005 PMCID: PMC8672235 DOI: 10.1001/jamanetworkopen.2021.37581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE It remains unknown whether children born at different degrees of prematurity, early term, and post term might have a higher risk of developmental coordination disorder (DCD) compared with completely full-term children (39-40 gestational weeks). OBJECTIVE To differentiate between suspected DCD in children with different gestational ages based on a national representative sample in China. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted in China from April 1, 2018, to December 31, 2019. A total of 152 433 children aged 3 to 5 years from 2403 public kindergartens in 551 cities of China were included in the final analysis. A multilevel regression model was developed to determine the strength of association for different gestational ages associated with suspected DCD when considering kindergartens as clusters. MAIN OUTCOMES AND MEASURES Children's motor performance was assessed using the Little Developmental Coordination Disorder Questionnaire, completed by their parents. Gestational age was determined according to the mother's medical records and divided into 7 categories: completely full term (39 to 40 weeks' gestation), very preterm (<32 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), early term (37-38 weeks), late term (41 weeks), and post term (>41 weeks). RESULTS A total of 152 433 children aged 3 to 5 years (mean [SD] age, 4.5 [0.8] years), including 80 370 boys (52.7%) and 72 063 girls (47.3%), were included in the study. There were 45 052 children (29.6%) aged 3 years, 59 796 (39.2%) aged 4 years, and 47 585 (31.2%) aged 5 years. Children who were born very preterm (odds ratio [OR], 1.35; 95% CI, 1.23-1.48), moderately preterm (OR, 1.18; 95% CI, 1.02-1.36), late preterm (OR, 1.24; 95% CI, 1.16-1.32), early term (OR, 1.11; 95% CI, 1.06-1.16), and post term (OR, 1.17; 95% CI, 1.07-1.27) were more likely to be classified in the suspected DCD category on the Little Developmental Coordination Disorder Questionnaire than completely full-term children after adjusting for the same characteristics. Additionally, there was no association with suspected DCD in younger (aged 3 years) early-term and postterm children by stratified analyses. CONCLUSIONS AND RELEVANCE In this cohort study, every degree of prematurity at birth, early-term birth, and postterm birth were associated with suspected DCD when compared with full-term birth. These findings have important implications for understanding motor development in children born at different gestational ages. Long-term follow-up and rehabilitation interventions should be considered for children born early and post term.
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Affiliation(s)
- Jing Hua
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Anna L. Barnett
- Centre for Psychological Research, Oxford Brookes University, Oxford, United Kingdom
| | - Gareth J. Williams
- School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - Xiaotian Dai
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuanjie Sun
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haifeng Li
- Department of Rehabilitation, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, China
| | - Guixia Chen
- Department of Children Healthcare, Women and Children’s Hospital, School of Medicine, Xiamen University, Fujian, China
| | - Lei Wang
- Department of Child Health Care, Maternal and Child Health Care Hospital of Yangzhou, Affiliated Hospital of Medical College Yangzhou University, Jiangsu, China
| | - Junyan Feng
- Department of Developmental Behaviour Pediatrics, The First Hospital of Jilin University, Jilin, China
| | - Yingchun Liu
- Maternity Service Center of Changchun Maternal & Child Health Care Hospital, Jilin, China
| | - Lan Zhang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan, China
| | - Ling Zhu
- Maternal and Child Health Hospital of Shanxi, Shanxi, China
| | - Tingting Weng
- Maanshan Maternal and Child Health Hospital of Anhui Province, Anhui, China
| | | | - Yue Gu
- School of Statistics, East China Normal University, Shanghai, China
| | - Yingchun Zhou
- School of Statistics, East China Normal University, Shanghai, China
| | - Andrew Butcher
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
| | - Wenchong Du
- Department of Psychology, Nottingham Trent University, Nottingham, United Kingdom
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30
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Abstract
White matter injury (WMI) represents a frequent form of parenchymal brain injury in preterm neonates. Several dimensions of WMI are recognized, with distinct neuropathologic features involving a combination of destructive and maturational anomalies. Hypoxia-ischemia is the main mechanism leading to WMI and adverse white matter development, which result from injury to the oligodendrocyte precursor cells. Inflammation might act as a potentiator for WMI. A combination of hypoxia-ischemia and inflammation is frequent in several neonatal comorbidities such as postnatal infections, NEC and bronchopulmonary dysplasia, all known contributors to WMI. White matter injury is an important predictor of adverse neurodevelopmental outcomes. When WMI is detected on neonatal brain imaging, a detailed characterization of the injury (pattern of injury, severity and location) may enhance the ability to predict outcomes. This clinically-oriented review will provide an overview of the pathophysiology and imaging diagnosis of the multiple dimensions of WMI, will explore the association between postnatal complications and WMI, and will provide guidance on the signification of white matter anomalies for motor and cognitive development.
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Affiliation(s)
- Mireille Guillot
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Toronto M5G 1X8, Canada; Department of Pediatrics (Neonatology), Université Laval and Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Steven P Miller
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Toronto M5G 1X8, Canada.
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31
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Ni Y, Mendonça M, Baumann N, Eves R, Kajantie E, Hovi P, Tikanmäki M, Räikkönen K, Heinonen K, Indredavik MS, Evensen KAI, Johnson S, Marlow N, Wolke D. Social Functioning in Adults Born Very Preterm: Individual Participant Meta-analysis. Pediatrics 2021; 148:peds.2021-051986. [PMID: 34702720 DOI: 10.1542/peds.2021-051986] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT There is a lack of research on individual perceptions of social experiences and social relationships among very preterm (VP) adults compared with term-born peers. OBJECTIVE To investigate self-perceived social functioning in adults born VP (<32 weeks' gestation) and/or with very low birth weight (VLBW) (<1500g) compared with term-born adults (≥37 weeks' gestation) using an individual participant data (IPD) meta-analysis. DATA SOURCES Two international consortia: Research on European Children and Adults born Preterm and Adults Born Preterm International Collaboration. STUDY SELECTION Cohorts with outcomes assessed by using the Adult Self-Report Adaptive Functioning scales (friends, spouse/partner, family, job, and education) in both groups. DATA EXTRACTION IPD from 5 eligible cohorts were collected. Raw-sum scores for each scale were standardized as z scores by using mean and SD of controls for each cohort. Pooled effect size was measured by difference (Δ) in means between groups. RESULTS One-stage analyses (1285 participants) revealed significantly lower scores for relationships with friends in VP/VLBW adults compared with controls (Δ -0.37, 95% confidence interval [CI]: -0.61 to -0.13). Differences were similar after adjusting for sex, age, and socioeconomic status (Δ -0.39, 95% CI: -0.63 to -0.15) and after excluding participants with neurosensory impairment (Δ -0.34, 95% CI: -0.61 to -0.07). No significant differences were found in other domains. LIMITATIONS Generalizability of research findings to VP survivors born in recent decades. CONCLUSIONS VP/VLBW adults scored their relationship with friends lower but perceived their family and partner relationships, as well as work and educational experiences, as comparable to those of controls.
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Affiliation(s)
- Yanyan Ni
- Department of Psychology, University of Warwick, Coventry, United Kingdom.,EGA Institute for Women's Health, University College London, London, United Kingdom
| | - Marina Mendonça
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Nicole Baumann
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Robert Eves
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Eero Kajantie
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Helsinki, Finland.,Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, Faculty of Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Children's Hospital, Helsinki University Hospital
| | - Petteri Hovi
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Helsinki, Finland.,Children's Hospital, Helsinki University Hospital
| | - Marjaana Tikanmäki
- Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Helsinki, Finland.,Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, Faculty of Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kati Heinonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Programs in Psychology and Comparative Social Policy and Welfare, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Marit S Indredavik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari-Anne I Evensen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway.,Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, United Kingdom
| | - Neil Marlow
- EGA Institute for Women's Health, University College London, London, United Kingdom
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, United Kingdom
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32
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Cobo-Vicente F, San Juan AF, Larumbe-Zabala E, Estévez-González AJ, Donadio MVF, Pérez-Ruiz M. Neuromuscular Electrical Stimulation Improves Muscle Strength, Biomechanics of Movement, and Functional Mobility in Children With Chronic Neurological Disorders: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6310565. [PMID: 34184031 DOI: 10.1093/ptj/pzab170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/10/2021] [Accepted: 05/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Chronic neurological disorders (CNDs) generally produce deleterious effects on the musculoskeletal system and can affect physical activity and increase sedentary behavior in children, hindering the execution of training programs and the attainment of a correct dose of exercise. The purpose of this systematic review was to analyze the effect of neuromuscular electrical stimulation (NMES) on skeletal muscle and then on biomechanics of movement, functional mobility, strength, spasticity, muscle architecture, and body composition of children and adolescents with CNDs and chronic diseases. METHODS The search was conducted in April 2020 in PubMed, MEDLINE, Scopus, the Cochrane Library, and Web of Science, without publication period restriction. Publications investigating the effect of NMES on children and adolescents with CNDs and other chronic diseases were independently selected by 2 researchers. One author independently extracted data from the studies selected, and a second author cross-checked. RESULTS Eighteen studies with 595 participants aged between 3 and 14 years were included. Quality assessment showed that 50% of the studies presented a low risk of bias. The pooled effect of NMES on gross motor functional measure, calculated as a standardized mean difference using a random effects model, was 0.41 (95% CI = 0.19-0.64). CONCLUSION The use of NMES programs for children diagnosed with cerebral palsy, spinal muscular atrophy, and obstetric injury of the brachial plexus was effective in improving muscle strength, biomechanics of movement, and functional mobility. IMPACT NMES can be a useful tool to prevent the reduction of mobility that results from CNDs.
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Affiliation(s)
| | - Alejandro F San Juan
- Sport Biomechanics Laboratory, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | | | | | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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33
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Vohr BR, McGowan EC, Bann C, Das A, Higgins R, Hintz S. Association of High Screen-Time Use With School-age Cognitive, Executive Function, and Behavior Outcomes in Extremely Preterm Children. JAMA Pediatr 2021; 175:1025-1034. [PMID: 34251406 PMCID: PMC8276120 DOI: 10.1001/jamapediatrics.2021.2041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Both preterm birth and increased screen time are known to be associated with an increase in risk of developmental and behavioral sequelae. The association between high screen time or a television or computer in the bedroom in early school age and adverse cognitive, executive function, language, and behavior outcomes of extremely preterm children (EPT) is not well understood. Objective To assess the association of high screen time with cognition, language, executive function, and behavior of EPT children aged 6 to 7 years; a second objective was to examine the association between high screen time and rates of structured physical activity and weight. Design, Setting, and Participants This cohort study was a secondary analysis from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial Neuroimaging and Neurodevelopmental Outcomes school-aged cohort and includes 414 EPT children born between February 1, 2005, and February 28, 2009, and evaluated in between 2012 and 2016 at ages 6 years 4 months to 7 years 2 months. The study was conducted from July 7, 2012, and August 15, 2016, and data were analyzed between December 10, 2018, and April 1, 2021. Exposures Cohorts included children exposed to low (≤2 hours per day) vs high (>2 hours per day) amounts of screen time and by the presence (no vs yes) of a television/computer in the bedroom. Main Outcomes and Measures In addition to growth parameters, assessments included the Wechsler Intelligence Scale for Children-IV, the Behavior Rating Inventory of Executive Function, the Developmental Neuropsychological Assessment, the Conners 3rd Edition-Parent Short-Form, and the Social Communication Questionnaire. Results Of the 414 children included in the analysis, 227 (55%) were boys; mean (SD) birth weight was 870.6 (191) g. A total of 238 children (57%) had high screen time and 266 (64%) had a television/computer in their bedroom. In multivariable linear regressions adjusted for center, male sex, gestational age, and social determinants of health, high screen time was independently associated with the following mean (SE) test score changes: lower full-scale IQ (-3.92 [1.64]; P = .02); an increase in association with deficits in executive functions, including metacognition (8.18 [3.01]; P = .007), global executive function (7.49 [2.99]; P = .01), inhibition (-0.79 [0.38]; P = .03), and Conners 3rd Edition-Parent Short-Form inattention (3.32 [1.67]; P = .047). A television/computer in the bedroom was associated with an increase in inhibition (-0.80 [0.39]; P = .04) and hyperactivity/impulsivity (3.50 [1.75]; P = .046) problems. Conclusions and Relevance The findings of this study suggest that high screen time contributes to adverse cognitive, executive function, and behavior outcomes at ages 6 to 7 years in children born at less than 28 weeks. These findings support the need for clinicians to have heightened awareness of the risks for EPT children and discuss both the benefits and risks of screen time with families.
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Affiliation(s)
- Betty R Vohr
- Division of Neonatal Medicine, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence
| | - Elisabeth C McGowan
- Division of Neonatal Medicine, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence
| | - Carla Bann
- Division of Statistical and Data Sciences, RTI International, Research Triangle Park, North Carolina
| | - Abhik Das
- Biostatistics and Epidemiology Division, RTI International, Rockville, Maryland
| | - Rosemary Higgins
- National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Bethesda, Maryland.,George Mason University, Fairfax, Virginia
| | - Susan Hintz
- Division of Perinatal Neonatal Medicine, Stanford University, Palo Alto, California
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34
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Hadas IM, Joseph M, Luba Z, Michal KL. Assessing parasympathetic measures of heart rate variability shortly after birth to predict motor repertoire at four months in low risk preterm infants born between 28 and 32 weeks of gestation. Early Hum Dev 2021; 161:105438. [PMID: 34392066 DOI: 10.1016/j.earlhumdev.2021.105438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
In low risk preterm infants, the risk for mild to moderate neuro-motor impairment is extremely high. Additionally, the autonomic nervous system (ANS) function was also found to be impaired. ANS activity may predict neuro-motor development at four months corrected age. This study examines the predictive value of the ANS function in detecting neuro-motor impairments during the first 4 months of life among low risk preterm infants born between 28 and 32 weeks of gestation. 46 infants were recruited. For each infant, heart rate variability (HRV) measures were obtained at week born, 32- and 35-weeks postmenstrual age (PMA). The General Movement Assessment (GMA) and the Motor Optimality Score for 3- to 5- Month- Old Infants (MOS) were performed at 35 weeks PMA and at 4 months corrected age respectively. A significant correlation was found between the parasympathetic nervous system (PSNS) components of HRV and the MOS evaluation. Preterm infants with suboptimal MOS scores showed significantly lower HRV values in the components of the PSNS (0.01 < p-value <0.04). A weak correlation was found between the HRV and the GMA. A Receiver Operating Characteristic was designed and revealed the predictive validity of the PSNS in preterm infants with a suboptimal MOS score. The current study shows that among very preterm infants with no additional risk factors, the PSNS component of HRV can predict neuro-motor outcome at 4 months corrected age and may be used as an early sign for mild neuro-motor impairments in order to initiate an early intervention program.
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Affiliation(s)
- Israeli-Mendlovic Hadas
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Mendlovic Joseph
- Shaare Zedek Medical Center, Jerusalem, Israel; Hadassah-Hebrew University School of Medicine, Jerusalem, Israel.
| | - Zuk Luba
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Katz-Leurer Michal
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
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35
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Carsone B, Green K, Torrence W, Henry B. Systematic Review of Visual Motor Integration in Children with Developmental Disabilities. Occup Ther Int 2021; 2021:1801196. [PMID: 34381323 PMCID: PMC8321716 DOI: 10.1155/2021/1801196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
Original research articles regarding visual motor integration skills in children with developmental disabilities and the impact of occupational therapy were identified, appraised, and synthesized. Twenty-four articles were chosen for this review. Themes were noted during the critique of articles. Three themes emerged: "age," "gender," and "diagnosis." Regarding the impact on visual motor integration, there was strong evidence for age, moderate evidence for gender, and strong evidence for diagnosis. Future research investigating visual motor integration in children should control for age and diagnosis.
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36
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Lee EJ, Zwicker JG. Early identification of children with/at risk of developmental coordination disorder: a scoping review. Dev Med Child Neurol 2021; 63:649-658. [PMID: 33469912 DOI: 10.1111/dmcn.14803] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
AIM To summarize current evidence for early identification and motor-based intervention for children aged 5 years and younger with/at risk of developmental coordination disorder (DCD). METHOD Using scoping review methodology and after duplicates were removed, 11 115 peer-reviewed articles and grey literature were independently screened by two authors. Data from 103 included records were extracted and synthesized by both assessors. One author entered the relevant data into tables, while the other author double-checked the entries. RESULTS Records included peer-reviewed studies, guidelines, conference presentations, and theses/dissertations. Most literature pertained to early identification (n=78), with fewer studies targeting intervention (n=22) or covering both topics (n=3). Literature was summarized in two main categories: (1) assessments for diagnostic criteria A and B; and (2) motor-based interventions for young children with/at risk of DCD. This article highlights the findings related to assessments, while a companion article summarizes the intervention literature. INTERPRETATION Emerging evidence shows that children, especially those at greatest risk of DCD, may be identified before formal school entry. Earlier identification will allow for earlier intervention, which may help to improve the developmental trajectories of children with/at risk of DCD and prevent secondary consequences of the disorder. It is recommended that health care providers explicitly use the term 'at risk of DCD'.
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Affiliation(s)
- Emily J Lee
- Rehabilitation Science Online Programs, University of British Columbia, Vancouver, British Columbia, Canada.,Nurture Society for Learning and Development, Vancouver, British Columbia, Canada
| | - Jill G Zwicker
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatrics, Division of Developmental Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Brain, Behaviour, and Development, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Sunny Hill Health Centre at BC Children's Hospital, Vancouver, British Columbia, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada
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37
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Gil-Madrona P, Romero-Martínez SJ, Roz-Faraco CC. Physical, Perceptual, Socio-Relational, and Affective Skills of Five-Year-Old Children Born Preterm and Full-Term According to Their Body Mass Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3769. [PMID: 33916587 PMCID: PMC8038435 DOI: 10.3390/ijerph18073769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 01/10/2023]
Abstract
The main purpose of this study was to compare the psychomotor development of five-year-old children born preterm and full term. The comparison included physical-motor, perceptual-motor, and socio-relational and affective skills. As low weight is one of the variables that most influences the psychomotor development of premature infants, a secondary aim was to analyze these skills according to their current body mass index (BMI). A prospective simple ex-post facto study was conducted. The sample consisted of 672 five-year-old children enrolled in the third year of early childhood education in the province of Albacete, Spain; 35 of them was born prematurely. Children were evaluated by their teachers using the Checklist of Psychomotor Activities (CPA). The results show that children born preterm had a lower development of their physical-motor skills. In the perceptual-motor field, premature children showed lower scores in the variables related to their body image and body schema, motor dissociation, and visual-motor coordination, as well as in socio-relational and affective aspects. However, the development in laterality, dynamic coordination, motor execution, tonic-postural control, and balance were not affected. These differences were not affected by the current weight, given that the analysis of the BMI indicated no differences in preterm children. This study demonstrated the need to establish protocols oriented to the prevention of the difficulties detected in children with psychomotor high-risk and the needs to reinforce the educational programs in this area to improve the integral development of children born preterm.
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Affiliation(s)
- Pedro Gil-Madrona
- Faculty of Education, Albacete, University of Castilla La Mancha, 13001 Ciudad Real, Spain
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38
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Spittle AJ, Dewey D, Nguyen TNN, Ellis R, Burnett A, Kwong A, Lee K, Cheong JLY, Doyle LW, Anderson PJ. Rates of Developmental Coordination Disorder in Children Born Very Preterm. J Pediatr 2021; 231:61-67.e2. [PMID: 33340547 DOI: 10.1016/j.jpeds.2020.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/05/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the stability of developmental coordination disorder (DCD) throughout childhood in children born very preterm and term. Further, in the very preterm group, to compare perinatal variables and neurobehavioral outcomes at 13 years of age for children with persisting DCD and those with typical motor development. STUDY DESIGN Prospective study of 180 very preterm and 73 term-born children assessed at 5, 7, and/or 13 years of age using the Movement Assessment Battery for Children, with scores ≤16th percentile used to classify DCD. Children with cerebral palsy or an IQ of <80 were excluded. RESULTS Children born very preterm had increased odds for DCD at 5 (OR, 5.53; 95% CI, 2.53-12.0; P < .001), 7 (OR, 3.63; 95% CI, 1.43-9.18; P = .06), and 13 years (OR, 4.34; 95% CI, 1.61-11.7; P = .004) compared with term-born children. The rates of DCD in very preterm children reduced from 47.9% at 5 years of age, to 28.5% at 7 years and 27.8% at 13 years of age (OR per year of age, 0.81; 95% CI, 0.75-0.87; P < .001), but less so for term-born children (15.3%, 10.0%, and 8.5% at 5, 7, and 13-years respectively [OR, 0.91; 95% CI, 0.75-1.09; P = .31]). Within the very preterm group at 13 years of age, there was evidence that children with persisting DCD performed poorer across several cognitive domains compared with children with typical motor development, with differences in the order of 0.5-1.0 SD. CONCLUSIONS Although the rates of DCD decreased across middle childhood for both groups, the odds for DCD were consistently higher for very preterm children compared with term, with important implications for cognitive functioning in the very preterm group.
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Affiliation(s)
- Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Research, Royal Women's Hospital, Melbourne, Australia.
| | - Deborah Dewey
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Thi-Nhu-Ngoc Nguyen
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Rachel Ellis
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Alice Burnett
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Research, Royal Women's Hospital, Melbourne, Australia
| | - Amanda Kwong
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Research, Royal Women's Hospital, Melbourne, Australia
| | - Katherine Lee
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jeanie L Y Cheong
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Research, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Research, Royal Women's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia; Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia; Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
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Mackay CA, Masekela R. HIV exposure and neurodevelopmental outcome in very low birth weight infants in a low-middle income setting: a prospective cohort study. AIDS Care 2021; 34:241-249. [PMID: 33764844 DOI: 10.1080/09540121.2021.1906403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neurodevelopmental impairment is common in premature infants. We aimed to describe neurodevelopmental outcomes in very low birth weight (VLBW) infants at 12 months postmenstrual age (PMA) and correlated with maternal HIV status. A single-centre, prospective cohort study was conducted from 1 June 2017 to 31 January 2019 with follow-up to 12 months. In-born infants with birth weight <1500 g were enrolled. Follow-up care was provided to 12 months PMA. Participants provided informed consent and ethics approval was obtained. A total of 279 patients were enrolled of which 84 (30.1%) died before 12 months and 91 (32.6%) were lost to follow-up. Neurodevelopmental assessment was performed on 104 participants. Mean general development quotient was 106.8, 2 (2.0%) patients had moderate-to-severe impairment and 1 (1.0%) mild impairment. HIV exposure was associated with lower developmental scores (104.3 vs. 109.0; p=0.005), whilst antenatal treatment with magnesium sulphate (109.6 vs. 105.2; p=0.01) and breastfeeding (108.0 vs. 104.0; p = 0.03) were associated with higher developmental scores. Neurodevelopmental outcome at 12 months PMA correlated with maternal HIV status. HIV exposure in VLBW infants is associated with lower neurodevelopmental scores at 12 months PMA. Antenatal treatment with magnesium sulphate and breastfeeding are associated with improved outcomes.
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Affiliation(s)
- Cheryl Anne Mackay
- Department of Paediatrics, Dora Nginza Hospital, Nelson Mandela Bay, Port Elizabeth, South Africa
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, Durban, South Africa
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40
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Smyrni N, Koutsaki M, Petra M, Nikaina E, Gontika M, Strataki H, Davora F, Bouza H, Damianos G, Skouteli H, Mastroyianni S, Dalivigka Z, Dinopoulos A, Tzaki M, Papavasiliou A. Moderately and Late Preterm Infants: Short- and Long-Term Outcomes From a Registry-Based Cohort. Front Neurol 2021; 12:628066. [PMID: 33643206 PMCID: PMC7907517 DOI: 10.3389/fneur.2021.628066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background: While most studies on the association of preterm birth and cerebral palsy (CP) have focused on very preterm infants, lately, attention has been paid to moderately preterm [32 to <34 weeks gestational age (GA)] and late preterm infants (34 to <37 weeks GA). Methods: In order to report on the outcomes of a cohort of moderately and late preterm infants, derived from a population-based CP Registry, a comparative analysis of data on 95 moderately preterm infants and 96 late preterm infants out of 1,016 with CP, was performed. Results: Moderately preterm neonates with CP were more likely to have a history of N-ICU admission (p = 0.001) and require respiratory support (p < 0.001) than late preterm neonates. Birth weight was significantly related to early neonatal outcome with children with lower birth weight being more likely to have a history of N-ICU admission [moderately preterm infants (p = 0.006)/late preterm infants (p < 0.001)], to require ventilator support [moderately preterm infants (p = 0.025)/late preterm infants (p = 0.014)] and not to have neonatal seizures [moderately preterm infants (p = 0.044)/late preterm infants (p = 0.263)]. In both subgroups, the majority of children had bilateral spastic CP with moderately preterm infants being more likely to have bilateral spastic CP and less likely to have ataxic CP as compared to late preterm infants (p = 0.006). The prevailing imaging findings were white matter lesions in both subgroups, with statistically significant difference between moderately preterm infants who required ventilator support and mainly presented with this type of lesion vs. those who did not and presented with gray matter lesions, maldevelopments or miscellaneous findings. Gross motor function was also assessed in both subgroups without significant difference. Among late preterm infants, those who needed N-ICU admission and ventilator support as neonates achieved worse fine motor outcomes than those who did not. Conclusions: Low birth weight is associated with early neonatal problems in both moderately and late preterm infants with CP. The majority of children had bilateral spastic CP and white matter lesions in neuroimaging. GMFCS levels were comparable in both subgroups while BFMF was worse in late preterm infants with a history of N-ICU admission and ventilator support.
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Affiliation(s)
- Nikoletta Smyrni
- Second Department of Neurology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Maria Koutsaki
- Third Pediatric Department, University General Hospital Attikon, Athens, Greece
| | - Marianna Petra
- Department of Orthopedics, Penteli Children's Hospital, Athens, Greece
| | - Eirini Nikaina
- Department of Pediatrics, Agia Sophia Children's Hospital, Athens, Greece
| | - Maria Gontika
- Department of Neurology, Evaggelismos General Hospital, Athens, Greece
| | - Helen Strataki
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotini Davora
- Department of Neurology, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Helen Bouza
- Department of Neonatal Intensive Care Unit, Agia Sophia Children's Hospital, Athens, Greece
| | - George Damianos
- Department of Neurology, Penteli Children's Hospital, Athens, Greece
| | - Helen Skouteli
- Department of Pediatric Neurology, IASO General Hospital, Athens, Greece
| | | | - Zoi Dalivigka
- Rehabilitation Center, Children's Hospital Aglaia Kyriakou, Athens, Greece
| | - Argyris Dinopoulos
- Third Pediatric Department, University General Hospital Attikon, Athens, Greece
| | - Margarita Tzaki
- Neonatal Intensive Care Unit, Elena Venizelou General Hospital, Athens, Greece
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Aravamuthan BR, Fehlings D, Shetty S, Fahey M, Gilbert L, Tilton A, Kruer MC. Variability in Cerebral Palsy Diagnosis. Pediatrics 2021; 147:e2020010066. [PMID: 33402528 PMCID: PMC7906070 DOI: 10.1542/peds.2020-010066] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common childhood motor disability. The emergence of genetic CP etiologies, variable inclusion of hypotonic CP in international registries, and involvement of different medical disciplines in CP diagnosis can promote diagnostic variability. This variability could adversely affect patients' understanding of their symptoms and access to care. Therefore, we sought to determine the presence and extent of practice variability in CP diagnosis. METHODS We surveyed physicians in the United States and Canada interested in CP on the basis of membership in the American Academy of Cerebral Palsy and Developmental Medicine or the Child Neurology Society Neonatal Neurology, Movement Disorders, or Neurodevelopmental Disabilities Special Interest Groups. The survey included the 2007 consensus definition of CP and 4 hypothetical case scenarios. RESULTS Of 695 contacted physicians, 330 (47%) completed the survey. Two scenarios yielded consensus: (1) nonprogressive spastic diplegia after premature birth with periventricular leukomalacia on brain MRI (96% would diagnose CP) and (2) progressive spastic diplegia (92% would not diagnose CP). Scenarios featuring genetic etiologies or hypotonia as the cause of nonprogressive motor disability yielded variability: only 46% to 67% of practitioners would diagnose CP in these settings. CONCLUSIONS There is practice variability in whether a child with a nonprogressive motor disability due to a genetic etiology or generalized hypotonia will be diagnosed with CP. This variability occurred despite anchoring questions with the 2007 consensus definition of CP. On the basis of these results, we have suggested ways to reduce diagnostic variability, including clarification of the consensus definition.
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Affiliation(s)
- Bhooma R Aravamuthan
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri;
| | - Darcy Fehlings
- Department of Pediatrics, University of Toronto and Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Sheetal Shetty
- Departments of Child Health, Neurology, Genetics, and Cellular and Molecular Medicine, College of Medicine - Phoenix, University of Arizona and Cerebral Palsy and Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona
| | - Michael Fahey
- Department of Paediatrics, Monash University, Melbourne, Australia; and
| | - Laura Gilbert
- Division of Pediatric Neurology, Department of Neurology, School of Medicine, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri
| | - Ann Tilton
- Louisiana State University Health Sciences Center New Orleans and Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Michael C Kruer
- Departments of Child Health, Neurology, Genetics, and Cellular and Molecular Medicine, College of Medicine - Phoenix, University of Arizona and Cerebral Palsy and Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona
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Baumann N, Tresilian J, Wolke D. Effects of infant motor problems and treatment with physiotherapy on child outcomes at school-age. Early Hum Dev 2020; 149:105140. [PMID: 32738517 DOI: 10.1016/j.earlhumdev.2020.105140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Early motor coordination problems have previously been associated with various developmental outcomes at school-age. AIMS Investigate whether and how treatment with physiotherapy may alter associations between early motor problems and subsequent developmental outcomes. STUDY DESIGN A prospective whole-population study. SUBJECTS 1374 children were followed from birth to 8 years. OUTCOME MEASURES Early motor functioning was determined with standard neurological examinations at birth and at 5 months. Information on receipt of physiotherapy was collected through parent interviews at 5, 20 and 56 months. Developmental outcomes at 6 and 8 years included motor skills, mental health, cognitive function, and attention regulation and were determined through standard tests, parent reports and observed behavior ratings. RESULTS Early motor problems were associated with lower motor skills, cognitive function, and attention regulation at school-age, but not with mental health. In addition to early motor problems, receipt of physiotherapy was independently and negatively related to outcomes at school-age. Accounting for imbalances in covariates, including initial motor scores, via propensity score matching attenuated the adverse effects of receipt of physiotherapy on school-aged outcomes. CONCLUSIONS Infant motor problems are associated with motor and cognitive outcomes at school-age. Early motor problems may represent a starting point of a trajectory of difficulties that may lead to a higher risk of problems in multiple developmental domains. No evidence for a beneficial effect of treatment with physiotherapy was found.
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Affiliation(s)
- Nicole Baumann
- Department of Psychology, University of Warwick, Coventry, United Kingdom.
| | - James Tresilian
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
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43
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Evensen KAI, Ustad T, Tikanmäki M, Haaramo P, Kajantie E. Long-term motor outcomes of very preterm and/or very low birth weight individuals without cerebral palsy: A review of the current evidence. Semin Fetal Neonatal Med 2020; 25:101116. [PMID: 32461044 DOI: 10.1016/j.siny.2020.101116] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We reviewed literature on long-term motor outcomes of individuals aged five years or older born very preterm (VP: ≤32 weeks of gestation) or with very low birth weight (VLBW: ≤1500g), without cerebral palsy (CP). PubMed produced 2827 articles, whereof 38 were eligible. Assessed by standardised and norm-based motor tests, the Movement Assessment Battery for Children being the most widely used, VP/VLBW individuals showed poorer motor skills compared with term-born controls with differences of approximately 1 SD in magnitude. Some studies assessed subdomains and differences were present in fine motor/manual dexterity, ball skills and gross motor/balance. Prevalence of motor problems varied largely from 8-37% in studies with cut-off at the 5th percentile or -1.5 SD to 12-71% in studies with cut-off at the 15th percentile or -1 SD. This review shows that the degree of motor impairments continues to be substantial among VP/VLBW individuals who do not develop CP.
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Affiliation(s)
- Kari Anne I Evensen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway; Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.
| | - Tordis Ustad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marjaana Tikanmäki
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Finnish Institute for Health and Welfare, Public Health Promotion Unit, Helsinki, Oulu, Finland
| | - Peija Haaramo
- Finnish Institute for Health and Welfare, Public Health Promotion Unit, Helsinki, Oulu, Finland
| | - Eero Kajantie
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Finnish Institute for Health and Welfare, Public Health Promotion Unit, Helsinki, Oulu, Finland; Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Early Motor Trajectories Predict Motor but not Cognitive Function in Preterm- and Term-Born Adults without Pre-existing Neurological Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093258. [PMID: 32392779 PMCID: PMC7246453 DOI: 10.3390/ijerph17093258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 12/16/2022]
Abstract
Very preterm (VP; <32 weeks gestation) and/or very low birth weight (VLBW; <1500 g) birth has been associated with an increased risk of adverse motor and cognitive outcomes that may persist into adulthood. The aim of this study was to determine whether motor development in the first five years of life is associated with motor and cognitive outcomes in adulthood. A prospective observational study in Germany followed 260 VP/VLBW and 229 term-born individuals from birth into adulthood. Early motor trajectories (i.e., high and low degree of motor difficulties) were determined from neurological examinations from birth to 56 months. Adult motor and cognitive outcomes were determined from information from multiple instruments and IQ tests, respectively. Associations of VP/VLBW birth and early motor difficulties on adult outcomes were assessed using regression analyses. VP/VLBW individuals had an increased risk for early motor difficulties (Relative Risk: 11.77, 95% confidence interval (CI): 4.28, 32.35). Early motor difficulties were associated with poorer motor competence in adulthood (β = 0.22, p < 0.001), independent of VP/VLBW birth. Adult IQ was predicted by VP/VLBW (β = −0.12, p < 0.05) and child IQ (β = 0.51, p < 0.001), while early motor difficulties ceased to be associated with adult IQ once participants with a neurological impairment were excluded (β = 0.02, p > 0.05). Motor problems in childhood were homotypically associated with poorer motor competence in adulthood. Similarly, early cognitive problems were homotypically associated with adult cognitive outcomes. Thus, both motor and cognitive function should be assessed in routine follow-up during childhood.
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45
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Wojcik MH, Stewart JE, Waisbren SE, Litt JS. Developmental Support for Infants With Genetic Disorders. Pediatrics 2020; 145:peds.2019-0629. [PMID: 32327449 PMCID: PMC7193975 DOI: 10.1542/peds.2019-0629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 01/03/2023] Open
Abstract
As the technical ability for genetic diagnosis continues to improve, an increasing number of diagnoses are made in infancy or as early as the neonatal period. Many of these diagnoses are known to be associated with developmental delay and intellectual disability, features that would not be clinically detectable at the time of diagnosis. Others may be associated with cognitive impairment, but the incidence and severity are yet to be fully described. These neonates and infants with genetic diagnoses therefore represent an emerging group of patients who are at high risk for neurodevelopmental disabilities. Although there are well-established developmental supports for high-risk infants, particularly preterm infants, after discharge from the NICU, programs specifically for infants with genetic diagnoses are rare. And although previous research has demonstrated the positive effect of early developmental interventions on outcomes among preterm infants, the impact of such supports for infants with genetic disorders who may be born term, remains to be understood. We therefore review the literature regarding existing developmental assessment and intervention approaches for children with genetic disorders, evaluating these in the context of current developmental supports postdischarge for preterm infants. Further research into the role of developmental support programs for early assessment and intervention in high-risk neonates diagnosed with rare genetic disorders is needed.
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Affiliation(s)
- Monica H. Wojcik
- Divisions of Newborn Medicine and,Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts; and
| | - Jane E. Stewart
- Divisions of Newborn Medicine and,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Susan E. Waisbren
- Genetics and Genomics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts; and
| | - Jonathan S. Litt
- Divisions of Newborn Medicine and,Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Abstract
OBJECTIVES The objectives of this study are to determine whether abnormalities on neonatal cranial ultrasound (CUS) are associated with minor motor abnormalities at 2 years' corrected age (CA) and to assess functional outcomes and resource utilization among children with minor motor abnormalities. METHODS Infants born at <27 weeks in the National Institute of Child Health and Human Development Neonatal Research Network between January 1, 2010, and December 31, 2014, who underwent neuroimaging with CUS at both <28 days and ≥28 days and were evaluated at 18 to 26 months' CA, were included. Follow-up included Bayley-3, neuromotor examination, Gross Motor Function Classification System (GMFCS) level, and parent questionnaires about special services and resource needs. Children were classified by the most severe motor abnormality at 18 to 26 months' CA as follows: none, minor, or major motor function abnormality. Minor motor abnormalities were defined as any of the following: (1) Bayley-3 motor composite, fine motor score, or gross motor score 1 to 2 SDs below the test normative means; (2) mild abnormalities of axial or extremity motor skills on standardized neuromotor examination; or (3) GMFCS level 1. RESULTS A total of 809 (35%) of 2306 children had minor motor function abnormalities alone. This did not increase substantially with CUS findings (no intraventricular hemorrhage [IVH]: 37%, grade I IVH: 32%, grade II IVH: 38%, grade III/IV IVH: 30%, isolated ventriculomegaly: 33%, and cystic periventricular leukomalacia: 24%). The adjusted odds of minor axial and upper extremity function abnormalities and GMFCS level 1 were significantly higher in children with more severe CUS findings. Children with minor motor abnormalities had increased resource utilization and evidence of functional impairment compared with those without motor function abnormalities. CONCLUSION Minor motor abnormalities at 2 years' CA are common and cannot be predicted by neonatal CUS abnormalities alone. Minor motor abnormalities are associated with higher resource utilization and evidence of functional impairment. These findings have important implications for early counseling and follow-up planning for extremely preterm infants.
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Baumann N, Tresilian J, Heinonen K, Räikkönen K, Wolke D. Predictors of early motor trajectories from birth to 5 years in neonatal at-risk and control children. Acta Paediatr 2020; 109:728-737. [PMID: 31442325 DOI: 10.1111/apa.14985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/12/2019] [Accepted: 08/21/2019] [Indexed: 11/26/2022]
Abstract
AIM To describe motor development in preschool children, to identify perinatal, neonatal and social environmental risk factors of poor motor development, and to replicate results in a second cohort. METHODS Two prospective samples in Germany (Bavarian Longitudinal Study, BLS) and Finland (Arvo Ylppö Longitudinal Study, AYLS) assessed 4741 and 1423 children from birth to 56 months, respectively. Motor functioning was evaluated at birth, and 5, 20 and 56 months. Perinatal, neonatal and social environmental information was collected at birth and 5 months. RESULTS Two distinct motor trajectories were identified: low (BLS: n = 4486 (94.6%), AYLS: n = 1391 (97.8%)) and high (BLS: n = 255 (5.4%), AYLS: n = 32 (2.2%)) degree of motor difficulties. High degree of motor difficulties was predicted by neonatal complications, abnormal neonatal neurological status, duration of hospitalisation and poor parent-infant relationships. Although neonatal complications and poor parent-infant relationships did not significantly predict high degree of motor difficulties in the AYLS, the trends identified were similar to those obtained from the BLS. CONCLUSION Early identification of children at-risk of motor difficulties across infancy and toddlerhood may help referring those children to interventions earlier. Modifiable risk factors, such as parent-infant relationships, may be addressed by intervention strategies to prevent children from developing motor difficulties.
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Affiliation(s)
- Nicole Baumann
- Department of Psychology University of Warwick Coventry UK
| | | | - Kati Heinonen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Katri Räikkönen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Dieter Wolke
- Department of Psychology University of Warwick Coventry UK
- Warwick Medical School University of Warwick Coventry UK
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Dorner RA, Allen MC, Robinson S, Soares BP, Perin J, Ramos E, Gerner G, Burton VJ. Early neurodevelopmental outcome in preterm posthemorrhagic ventricular dilatation and hydrocephalus: Neonatal ICU Network Neurobehavioral Scale and imaging predict 3-6-month motor quotients and Capute Scales. J Neurosurg Pediatr 2020; 25:217-227. [PMID: 31860810 PMCID: PMC7305038 DOI: 10.3171/2019.9.peds19438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/16/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Brain injury remains a serious complication of prematurity. Almost half of infants with severe intraventricular hemorrhage (IVH) develop posthemorrhagic ventricular dilatation (PHVD) and 20% need surgery for posthemorrhagic hydrocephalus (PHH). This population is associated with an increased risk of later neurodevelopmental disability, but there is uncertainty about which radiological and examination features predict later disability. In this study the authors sought to devise and describe a novel combination of neurobehavioral examination and imaging for prediction of neurodevelopmental disability among preterm infants with PHVD and PHH. METHODS The study patients were preterm infants (< 36 weeks gestation) with IVH and PHVD, with or without PHH. Ventricular index (VI), anterior horn width (AHW), thalamooccipital distance (TOD), ventricle/brain (V/B) ratio, and resistive indices (RIs) were recorded on the head ultrasound (HUS) just prior to surgery, or the HUS capturing the worst PHVD when surgery was not indicated. The posterior fossa was assessed with MRI. Neonatal ICU Network Neurobehavioral Scale (NNNS) examinations were performed at term age equivalent for each infant. A neurodevelopmental assessment using the Capute Scales (Capute Cognitive Adaptive Test [CAT] scores and Capute Clinical Linguistic Auditory Milestone Scale [CLAMS] scores) and a motor quotient (MQ) assessment were performed between 3 and 6 months of age corrected for degree of prematurity (corrected age). MQs < 50 reflect moderate to severe delays in early motor milestone attainment, CAT scores < 85 reflect delays in early visual and problem-solving abilities, and CLAMS scores < 85 reflect delays in early language. RESULTS Twenty-one infants underwent assessments that included imaging and NNNS examinations, Capute Scales assessments, and MQs. NNNS nonoptimal reflexes (NOR) and hypertonicity subscores and AHW were associated with MQs < 50: NOR subscore OR 2.46 (95% CI 1.15-37.6, p = 0.034), hypertonicity subscore OR 1.68 (95% CI 1.04-3.78, p = 0.037), and AHW OR 1.13 (95% CI 1.01-1.39, p = 0.041). PVHI, cystic changes, and neurosurgical intervention were associated with CAT scores < 85: PVHI OR 9.2 (95% CI 1.2-73.2, p = 0.037); cystic changes OR 12.0 (95% CI 1.0-141.3, p = 0.048), and neurosurgical intervention OR 11.2 (95% CI 1.0-120.4, p = 0.046). Every 1-SD increase in the NOR subscore was associated with an increase in odds of a CAT score < 85, OR 4.0 (95% CI 1.0-15.0, p = 0.044). Worse NNNS NOR subscores were associated with early language delay: for a 1-SD increase in NOR subscore, there was an increase in the odds of a CLAMS score < 85, OR 19.5 (95% CI 1.3-303, p = 0.034). CONCLUSIONS In former preterm children with severe IVH and PHVD, neonatal neurological examination findings and imaging features are associated with delays at 3-6 months in motor milestones, visual and problem-solving abilities, and language.
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Affiliation(s)
- Rebecca A. Dorner
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine
- Neurosciences Intensive Care Nursery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Marilee C. Allen
- Division of Perinatal-Neonatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine
- Neurosciences Intensive Care Nursery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Shenandoah Robinson
- Neurosciences Intensive Care Nursery, Johns Hopkins Hospital, Baltimore, Maryland
- Pediatric Neurosurgery, Johns Hopkins University School of Medicine
| | - Bruno P. Soares
- Radiology, University of Vermont Medical Center, Burlington, Vermont
| | - Jamie Perin
- Bloomberg School of Public Health, Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University, Baltimore, Maryland
| | - Ezequiel Ramos
- Medical Doctorate Program, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Vera Joanna Burton
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Neurology, Johns Hopkins University School of Medicine
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Ouellet-Scott N, Gagnon M, Fortin P, Girouard-Chantal É, Peckre P, Martini R, Lambert J, Luu TM, Simard MN. Screening for mild to moderate motor impairments in very preterm children: Utility of parent questionnaires. Early Hum Dev 2020; 141:104940. [PMID: 31862628 DOI: 10.1016/j.earlhumdev.2019.104940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/15/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Nellie Ouellet-Scott
- Research Center, Centre Hospitalier Universitaire Ste-Justine, Montreal, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Mélanie Gagnon
- Research Center, Centre Hospitalier Universitaire Ste-Justine, Montreal, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Pascale Fortin
- Research Center, Centre Hospitalier Universitaire Ste-Justine, Montreal, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Élise Girouard-Chantal
- Research Center, Centre Hospitalier Universitaire Ste-Justine, Montreal, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Perrine Peckre
- Research Center, Centre Hospitalier Universitaire Ste-Justine, Montreal, Canada
| | - Rose Martini
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Jean Lambert
- School of Public Health, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Thuy Mai Luu
- Research Center, Centre Hospitalier Universitaire Ste-Justine, Montreal, Canada; Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Marie-Noëlle Simard
- Research Center, Centre Hospitalier Universitaire Ste-Justine, Montreal, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.
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