Developmental coordination disorder in extremely low birth weight children at nine years

Visuospatial Perception in Prematurely Born Children Without Cerebral Palsy or Retinopathy but With Scholar Complaints

In the absence of any complaints in early childhood, preterm children remain more at risk of encountering academic difficulties, but their clinical picture remains not well characterized. We screened visuospatial perception in 70 children born preterm consulting for scholar complaints. Developmental Coordination Disorder (with or without comorbidities) was associated with high prevalence (27%) of impaired perception of spatial relationship. Prematurely born children who obtained no diagnosis of Neuro-Developmental Disorder exhibited a high prevalence (31%) of impaired perception of object magnitude. Regression revealed that low gestational age and fetal growth restriction significantly predicted the magnitude but not the spatial relationship perception.

Diagnostic accuracy of the Hammersmith Neonatal Neurological Examination in predicting motor outcome at 12 months for infants born very preterm

AIM

To evaluate the predictive validity of the Hammersmith Neonatal Neurological Examination (HNNE) performed early (at 32 weeks postmenstrual age) and at term-equivalent age (TEA) for 12-month motor outcomes in infants born very preterm.

METHOD

This was a diagnostic study using data from a prospective birth cohort. A total of 104 infants born preterm at less than 31 weeks gestational age (males n = 61; mean = 28 weeks 1 day [SD 1 week 6 days], range 23 weeks 1 day-30 weeks 6 days) underwent HNNE early and at TEA, which were scored by comparison with term data. Motor outcomes at 12 months corrected age were determined using the Bayley Scales of Infant and Toddler Development, Third Edition (scores ≤85). Cut-off points were determined using receiver operating characteristic curves.

RESULTS

Sixteen (15%) infants born preterm had motor impairment at 12 months corrected age. The HNNE total score cut-off points with the best combination of sensitivity and specificity at early and TEA assessments were 15.2 or lower (sensitivity 77%, 95% confidence interval [CI] = 46%-95%; specificity 74%, 95% CI = 63%-83%) and 23.5 or lower (sensitivity 67%, 95% CI = 38%-88%; specificity 66%, 95% CI = 54%-76%) respectively. The most predictive subscale at the early assessment was reflexes (sensitivity 86%, 95% CI = 57%-98%; specificity 62%, 95% CI = 51%-72%; cut-off point ≤3); at TEA, it was spontaneous movements (sensitivity 73%, 95% CI = 45%-92%; specificity 60%, 95% CI = 48%-70%; cut-off point ≤2).

INTERPRETATION

The HNNE provides moderate predictive accuracy for motor outcome at 12 months corrected age in infants born very preterm. Although modest at both time points, early assessment had stronger predictive ability for motor outcomes than TEA when scored using term data, highlighting the value of performing the HNNE earlier in the neonatal period. Performing HNNE earlier may assist risk stratification when planning follow-up services.

Association between General Movements Assessment and Later Motor Delay (excluding Cerebral Palsy) in Low-Birth-Weight Infants

The general movements (GMs) assessment is useful for the prediction of cerebral palsy (CP) and other developmental disorders. Developmental coordination disorder (DCD) is highly prevalent in low-birth-weight (LBW) infants. We investigated the association between aberrant GMs during early infancy and later motor development in LBW infants. The study included infants who fulfilled the following criteria: GMs assessed at 9–20 weeks post-term age; developmental quotient (DQ) assessed at 3 years of age using the Kyoto Scale; intelligence quotient (IQ) assessed at 6 years of age. Participants with normal IQs at 6 years of age without a diagnosis of CP (14 males and 37 females, 23–36 weeks gestation with birth weights of 492–1498 g) were categorized into normal (n = 39) and aberrant (n = 12) groups based on GMs assessment; DQ was compared between the groups. We investigated the items in the DQ assessment and found that the infants in the aberrant group were more frequently unable to perform. Infants in the aberrant group showed a significantly lower DQ in the ‘postural-motor domain’, and were more frequently unable to ‘climb the stairs with alternating legs’ and ‘Jump from a 15–20 cm platform’. This study highlights that GMs aberrancy in early infancy is associated with a delayed gross motor development, even in children with a typical development. The GMs assessment may be useful for the prediction of DCD.

The impact of premature extrauterine exposure on infants' stimulus-evoked brain activity across multiple sensory systems

Prematurity can result in widespread neurodevelopmental impairment, with the impact of premature extrauterine exposure on brain function detectable in infancy. A range of neurodynamic and haemodynamic functional brain measures have previously been employed to study the neurodevelopmental impact of prematurity, with methodological and analytical heterogeneity across studies obscuring how multiple sensory systems are affected. Here, we outline a standardised template analysis approach to measure evoked response magnitudes for visual, tactile, and noxious stimulation in individual infants (n = 15) using EEG. By applying these templates longitudinally to an independent cohort of very preterm infants (n = 10), we observe that the evoked response template magnitudes are significantly associated with age-related maturation. Finally, in a cross-sectional study we show that the visual and tactile response template magnitudes differ between a cohort of infants who are age-matched at the time of study but who differ according to whether they are born during the very preterm or late preterm period (n = 10 and 8 respectively). These findings demonstrate the significant impact of premature extrauterine exposure on brain function and suggest that prematurity can accelerate maturation of the visual and tactile sensory system in infants born very prematurely. This study highlights the value of using a standardised multi-modal evoked-activity analysis approach to assess premature neurodevelopment, and will likely complement resting-state EEG and behavioural assessments in the study of the functional impact of developmental care interventions.

Diffusion Tensor Imaging in Very Preterm, Moderate-Late Preterm and Term-Born Neonates: A Systematic Review

OBJECTIVE

To examine white matter abnormalities, measured by diffusion tensor imaging, in very preterm (<32 weeks) and moderate-late preterm neonates (32-37 weeks) at term-equivalent age, compared with healthy full-term controls (≥37 weeks).

STUDY DESIGN

A search of Medline (PubMed) was conducted to identify studies with diffusion data collected on very preterm, moderate-late preterm and full-term neonates, using the guidelines from the Meta-analysis of Observational Studies in Epidemiology and PRISMA statements.

RESULTS

Eleven studies were included with diffusion tensor imaging data from 554 very preterm, 575 moderate-late preterm, and 318 full-term neonates. Widespread statistically significant diffusion measures were found in all preterm subgroups at term-equivalent age compared with full-term neonates, and this difference was more marked for the very preterm group. These abnormalities are suggestive of changes in the white matter microstructure in the preterm groups. The corpus callosum was a region of interest in both early and moderate-late preterm groups, which showed statistically significant diffusion measures in all 11 studies.

CONCLUSIONS

Microstructural white matter changes may underpin the increased risk of neurodevelopmental disability seen in preterm infants in later life. diffusion tensor imaging may therefore be a useful prognostic tool for neuro-disability in preterm neonates.

Risk factors in early life for developmental coordination disorder: a scoping review

AIM

To perform a scoping literature review of associations between risk factors in early life and developmental coordination disorder (DCD).

METHOD

PubMed, Embase, CINAHL, PsycINFO, and Web of Science (January 1994-March 2019) were searched to identify studies on early risk factors and motor impairment or DCD. The effect of single and multiple risk factors was assessed. Level of evidence was evaluated following the Centre for Evidence-Based Medicine guidelines. Meta-analysis on the effect of preterm birth was performed.

RESULTS

Thirty-six studies fulfilled inclusion criteria; 35 had evidence level 3, one had level 4. Highest evidence was available that preterm birth and male sex in term-born children were associated with DCD. The odds ratio of preterm birth was 2.02 (95% confidence interval: 1.43-2.85). Low to moderate evidence was available that parental subfertility, maternal smoking during pregnancy, postnatal corticosteroid treatment in infants born preterm, extra corporeal membrane oxygenation, retinopathy of prematurity, abnormalities on magnetic resonance imaging scans at term age, and accumulating perinatal or neonatal risk factors were associated with motor impairment.

INTERPRETATION

Limited information on early risk factors of DCD is available. Only preterm birth and male sex were consistently associated with an increased risk of DCD.

WHAT THIS PAPER ADDS

Preterm birth is a risk factor for developmental coordination disorder (DCD). In term-born children, male sex was consistently associated with DCD. Risk factors for DCD are similar to risk factors for cerebral palsy.

Neurodevelopmental outcomes at age 5 among children born preterm: EPIPAGE-2 cohort study

OBJECTIVES

To describe neurodevelopment at age 5 among children born preterm.

DESIGN

Population based cohort study, EPIPAGE-2.

SETTING

France, 2011.

PARTICIPANTS

4441 children aged 5½ born at 24-26, 27-31, and 32-34 weeks MAIN OUTCOME MEASURES: Severe/moderate neurodevelopmental disabilities, defined as severe/moderate cerebral palsy (Gross Motor Function Classification System (GMFCS) ≥2), or unilateral or bilateral blindness or deafness, or full scale intelligence quotient less than minus two standard deviations (Wechsler Preschool and Primary Scale of Intelligence, 4th edition). Mild neurodevelopmental disabilities, defined as mild cerebral palsy (GMFCS-1), or visual disability ≥3.2/10 and <5/10, or hearing loss <40 dB, or full scale intelligence quotient (minus two to minus one standard deviation) or developmental coordination disorders (Movement Assessment Battery for Children, 2nd edition, total score less than or equal to the fifth centile), or behavioural difficulties (strengths and difficulties questionnaire, total score greater than or equal to the 90th centile), school assistance (mainstream class with support or special school), complex developmental interventions, and parents' concerns about development. The distributions of the scores in contemporary term born children were used as reference. Results are given after multiple imputation as percentages of outcome measures with exact binomial 95% confidence intervals.

RESULTS

Among 4441 participants, 3083 (69.4%) children were assessed. Rates of severe/moderate neurodevelopmental disabilities were 28% (95% confidence interval 23.4% to 32.2%), 19% (16.8% to 20.7%), and 12% (9.2% to 14.0%) and of mild disabilities were 38.5% (33.7% to 43.4%), 36% (33.4% to 38.1%), and 34% (30.2% to 37.4%) at 24-26, 27-31, and 32-34 weeks, respectively. Assistance at school was used by 27% (22.9% to 31.7%), 14% (12.1% to 15.9%), and 7% (4.4% to 9.0%) of children at 24-26, 27-31, and 32-34 weeks, respectively. About half of the children born at 24-26 weeks (52% (46.4% to 57.3%)) received at least one developmental intervention which decreased to 26% (21.8% to 29.4%) for those born at 32-34 weeks. Behaviour was the concern most commonly reported by parents. Rates of neurodevelopment disabilities increased as gestational age decreased and were higher in families with low socioeconomic status.

CONCLUSIONS

In this large cohort of children born preterm, rates of severe/moderate neurodevelopmental disabilities remained high in each gestational age group. Proportions of children receiving school assistance or complex developmental interventions might have a significant impact on educational and health organisations. Parental concerns about behaviour warrant attention.

Adaptive Behavioral, Social-Emotional, and Neurodevelopmental Outcomes at 2 Years of Age in Hungarian Preterm Infants Based on Bayley III

AIM

 This study aimed to assess cognitive, language, and motor development as well as social-emotional and adaptive behavior skills of low birthweight (LBW) children.

METHODS

Our cohort contained 305 two-year-old LBW children. Developmental functioning was assessed by the Bayley Scales of Infant and Toddler Development, 3^rd Edition.

RESULTS

Performance in language, particularly in expressive communication was the poorest. Extremely low birthweight (ELBW) children were found to be at increased risk of developmental delay: 12.73 times in motor (95%CI = 2.8-57.5), 9.81 times in cognitive (95%CI = 3.2-29.6) and 3.91 times in language (95%CI = 1.6-9.4), and social-emotional skills (95%CI = 1.6-9.5). Parents of children with lower birthweight reported poorer social and practical adaptive skills. Self-care domain seemed to be the least developed.

CONCLUSION

Additionally, the screening for developmental delays, monitoring the adaptive behavior skills may also be useful - especially among ELBW children - in order to identify the specific areas, situations, and functions that are most in need of interventions.

ABBREVIATIONS

AB: Adaptive Behavior; ABAS-II: Adaptive Behavior Assessment System-II; BPD: Bronchopulmonary Dysplasia; BSID-III: Bayley Scales of Infant Development 3^rd Edition; BW: Birthweight; CI: Confidence Interval; CS: Composite Score; ELBW: Extremely Low Birthweight; GA: Gestational Age; IVF: In Vitro Fertilization; IVH: Intraventricular Hemorrhage; LBW: Low Birthweight; NEC: Necrotizing Enterocolitis; OR: Odds Ratio; ROP: Retinopathy of Prematurity; SE: Social-Emotional Development; VLBW: Very Low Birthweight.

Neurodevelopmental outcomes in very preterm infants: The role of severity of Bronchopulmonary Dysplasia

OBJECTIVE

Bronchopulmonary dysplasia is a chronic respiratory disease that still affects preterm neonates; its association with neurodevelopmental (ND) impairment is already known. Different studies investigated neurodevelopmental outcomes in infants with BPD, often using the old dichotomous definition (BPD vs Non-BPD). This retrospective study aims to evaluate the role of different BPD severity grades on ND outcomes at 24 months of corrected age (CA).

METHODS

All preterm infants born between 2011 and 2015 in the study hospital with a gestational age (GA) ≤ 30 weeks and discharged from our NICU were included and were divided in infants with and without BPD. Infants with BPD were divided into three severity groups as defined by NICHD/NHLBI Workshop in 2001, and were compared to their Non-BPD peers, matching them according to the same GA and year of birth. At 24 months postmenstrual age, we assessed general outcomes (growth and hospital readmissions) and neurodevelopmental outcomes (motor, developmental and sensory outcomes) with a standardized assessment.

RESULTS

We enrolled 89 patients affected by BPD of different grades of severity and a control group of 89 preterm infants without BPD. Infants with Moderate and Severe BPD showed a significantly higher corrected odds ratio (OR) for cognitive impairment compared to controls. Within the group of infants without severe disability (regarding Griffiths' scales), infants with Moderate and Severe BPD as well as infants with Mild BPD showed a significantly higher risk of a lower total Developmental Quotient (DQ) score, even after correction for confounding factors.

CONCLUSIONS

Our study evidenced that not only Severe BPD infants, but also Moderate ones showed a higher risk of overall cognitive impairment at 24 months CA. Within the group of infants without severe disability, also those with Mild BPD had lower Griffiths DQ scores than those without. This would suggest that infants with BPD, regardless of severity, warrant neurodevelopmental follow-up.

International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder - Chinese (Mandarin) translation

目的

本国际临床指南由欧洲残疾儿童学会（the European Academy of Childhood Disability，EACD）牵头制定，旨在解决发育性协调障碍（developmental coordination disorder，DCD）的定义、诊断、评估、干预以及与社会心理方面的临床应用关键问题。

方法

本指南针对五个领域的关键问题，通过文献综述和专家团队的正式讨论达成共识。为保证指南的循证基础，以“机制”、“评估”和“干预”为检索词, 对2012年更新以来提出的最新建议以及新增的“社会心理问题”和“青少年/成人”为检索词进行检索。根据牛津大学循证医学中心证据等级 (证据水平 [level of evidence, LOE]1–4) 将结果进行分类，最终转化为指南建议。并由国际、多学科专家小组举行了两次会议，5个回合的Delphi 专家问卷调查，制定了高质量临床应用实践 (good clinical practice，GCP) 。

结果

本指南共制定35条建议。其中8条以文献综述为依据 (3 条涉及“评估”，5条涉及“干预”)； 22 条在 2012 年指南的基础上进行了更新；其他为涉及诊断、评估 (3条GCP) 及社会心理问题 (2 条 GCP) 的新建议。此外，其中有1条(LOE)新建议提出视频游戏可作为以活动和参与为导向的传统干预措施的辅助手段，并针对青少年和成人DCD提出了 2 条新建议 (1 条 GCP，1 条 LOE)。

结论

本指南是基于当前的研究证据和专家共识对DCD进行全面概述。它反映了不同学科临床和科研人员的最新科技水平。本国际指南可作为各国制定指南的基础。

The prenatal, postnatal, neonatal, and family environmental risk factors for Developmental Coordination Disorder: A study with a national representative sample

Knowledge of obstetric and environmental influences on Developmental Coordination Disorder (DCD) helps provide increased understanding of the mechanisms underlying the disorder. However, the literature to date has not adequately examined the obstetric and environmental risk factors for DCD in a population-based sample. The current study was therefore conducted to explore the prenatal, perinatal, neonatal, and family environmental risk factors for DCD. A total of 2185 children aged 3-10 years from a national representative sample in China were included; the Movement Assessment Battery for Children-2 was used to assess motor function, and a questionnaire was completed by parents. DCD was identified in 156 children according to the DSM-5 criteria. Multilevel logistic regression was used, and comparisons were made between the DCD and non-DCD group. The results confirmed that male sex, BMI score, preterm birth, and some prenatal conditions are significant risk factors for DCD. Parents' education level and one-child status as two significant environmental risk factors for DCD appear largely independent of other risk factors in the Chinese population. This study provides an opportunity to explore the etiology of DCD and suggest potential assessment, monitoring and intervention programs for DCD that could be examined in the future.

Long-term motor outcomes of very preterm and/or very low birth weight individuals without cerebral palsy: A review of the current evidence

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.

Putting a Finger on Numerical Development - Reviewing the Contributions of Kindergarten Finger Gnosis and Fine Motor Skills to Numerical Abilities

The well-documented association between fingers and numbers is not only based on the observation that most children use their fingers for counting and initial calculation, but also on extensive behavioral and neuro-functional evidence. In this article, we critically review developmental studies evaluating the association between finger sensorimotor skills (i.e., finger gnosis and fine motor skills) and numerical abilities. In sum, reviewed studies were found to provide evidential value and indicated that both finger gnosis and fine motor skills predict measures of counting, number system knowledge, number magnitude processing, and calculation ability. Therefore, specific and unique contributions of both finger gnosis and fine motor skills to the development of numerical skills seem to be substantiated. Through critical consideration of the reviewed evidence, we suggest that the association of finger gnosis and fine motor skills with numerical abilities may emerge from a combination of functional and redeployment mechanisms, in which the early use of finger-based numerical strategies during childhood might be the developmental process by which number representations become intertwined with the finger sensorimotor system, which carries an innate predisposition for said association to unfold. Further research is nonetheless necessary to clarify the causal mechanisms underlying this association.

Childhood Motor Coordination and Adult Affective Experience Among Extremely Low Birth Weight Survivors

Poor motor coordination in childhood has been associated in adulthood with more negative affect, less positive affect, and an increased risk of psychopathology. While survivors of extremely low birth weight (ELBW; < 1,000 grams) are more likely to manifest poor motor coordination than people born at normal birth weight (NBW; > 2,500 g), they have had better mental health outcomes than those with NBW who have motor difficulties. How emotion is experienced is an important risk factor for mental illness; yet, little is known about the affective experience of survivors of ELBW who also have poor motor coordination. In this longitudinal study, we examined interactions between birth weight status and childhood motor coordination on affective experience among 88 ELBW and 89 NBW participants. We first assessed childhood motor coordination at eight years of age, using the Bruininks-Oseretsky Test of Motor Proficiency, and we later gathered self-report data regarding affective style, using the Positive and Negative Affect Scedule and the Affective Styles Questionnaire, when these participants were 30-35 years of age. We found a statistically significant interaction between motor coordination and birth weight status. As motor coordination worsened among ELBW survivors, positive affect increased, while we observed the opposite trend in NBW participants (p < 0.05). There was no interaction for negative affect. Positive affect may contribute to previous findings of better relative adult mental health among ELBW survivors with poor childhood motor coordination. Strategies aimed at optimizing positive affect may be fruitful for optimizing mental health outcomes among preterm survivors and others with reduced motor proficiency.

International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder

AIM

These international clinical practice recommendations (CPR) for developmental coordination disorder (DCD), initiated by the European Academy of Childhood Disability (EACD), aim to address key questions on the definition, diagnosis, assessment, intervention, and psychosocial aspects of DCD relevant for clinical practice.

METHOD

Key questions in five areas were considered through literature reviews and formal expert consensus. For recommendations based on evidence, literature searches on 'mechanisms', 'assessment', and 'intervention' were updated since the last recommendations in 2012. New searches were conducted for 'psychosocial issues' and 'adolescents/adults'. Evidence was rated according to the Oxford Centre for Evidence-Based Medicine (level of evidence [LOE] 1-4) and transferred into recommendations. For recommendations based on formal consensus, two meetings of an international, multidisciplinary expert panel were conducted with a further five Delphi rounds to develop good clinical practice (GCP) recommendations.

RESULTS

Thirty-five recommendations were made. Eight were based on the evidence from literature reviews (three on 'assessment', five on 'intervention'). Twenty-two were updated from the 2012 recommendations. New recommendations relate to diagnosis and assessment (two GCPs) and psychosocial issues (three GCPs). Additionally, one new recommendation (LOE) reflects active video games as adjuncts to more traditional activity-oriented and participation-oriented interventions, and two new recommendations (one GCP, one LOE) were made for adolescents and adults with DCD.

INTERPRETATION

The CPR-DCD is a comprehensive overview of DCD and current understanding based on research evidence and expert consensus. It reflects the state of the art for clinicians and scientists of varied disciplines. The international CPR-DCD may serve as a basis for national guidelines.

WHAT THIS PAPER ADDS

Updated international clinical practice guidelines on developmental coordination disorder (DCD). Refined and extended recommendations on clinical assessment and intervention for DCD. A critical synopsis of current research on mechanisms of DCD. A critical synopsis of psychosocial issues in DCD, with implications for clinical practice. The first international recommendations to consider adolescents and adults with DCD.

Physical fitness of non-disabled school-aged children born with extremely low birth weights

BACKGROUND

The assessment of long-term outcomes in survivors born with extremely low birth weights (ELBWs) has become increasingly important. However, little has been reported on the physical fitness of non-disabled school-aged children born with ELBWs.

AIMS

To assess the physical fitness of non-disabled school-aged children born with ELBWs.

STUDY DESIGN

Retrospective cohort study.

SUBJECTS

We analyzed 169 ELBW infants without cerebral palsy or intellectual disability (based on the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) Full Scale intelligence quotient (IQ) test < 70).

OUTCOME MEASURES

Physical fitness was assessed using the grip strength, sit-up repetitions, sit & reach, side steps, standing long jump, and softball throw tests. T-scores were calculated using national survey data.

RESULTS

The T-scores for the grip strength, sit-up repetitions, sit & reach, side steps, standing long jump, softball throw tests, and the overall T-score were 43.7 ± 7.5, 44.2 ± 10.5, 46.0 ± 9.7, 40.9 ± 8.0, 40.0 ± 9.8, 42.4 ± 8.1, and 42.9 ± 5.5, respectively. After adjusting for other age-related factors, the height (SD score), WISC-III Performance IQ score, and percent predicted forced vital capacity (FVC) independently predicted the overall T-scores. Their standardized partial regression coefficients (β) were 0.334 (p = 0.009), 0.190 (p = 0.022), and 0.187 (p = 0.032), respectively.

CONCLUSIONS

Our cohort's physical fitness at approximately 8 years of age was significantly impaired compared to average Japanese children of the same age. Height, FVC, and Performance IQ independently predicted physical fitness, with height being the strongest predictor.

What Are We Measuring as Outcome? Looking Beyond Neurodevelopmental Impairment

Outcomes of neonatal intensive care unit (NICU) graduates have been categorized by rates of neurodevelopmental impairment at 2 years old. Although useful as metrics for research, these early childhood assessments may underestimate or overestimate later functional capabilities. Often overlooked are less severe but more prevalent neurobehavioral dysfunctions seen later in childhood, and chronic health concerns that may impact the child's quality of life (QoL). Comprehensive NICU follow-up should include measures of less severe cognitive/learning delays, physical/mental well-being, and the promotion of resilience in children and families. Studies are needed to identify QoL measures that will optimize children's assessments and outcomes.

Gross Motor Outcomes of Children Born Prematurely in Northern Ontario and Followed by a Neonatal Follow-Up Programme

Purpose: The developing brain of a premature infant is vulnerable to injury. As a result, the long-term consequences of a premature birth include motor deficits, cognitive and behavioural problems. It is crucial to identify motor dysfunction during the preschool period because it interferes with a child's ability to explore the world. The goals of this study were to (1) provide preliminary data on the gross motor outcomes of children born prematurely and (2) determine the proportion and characteristics of the children who had maintained delays over the course of follow-up. Method: A retrospective chart review was conducted on all infants monitored by a neonatal follow-up programme. Each child was assessed by a single physiotherapist from birth until age 2 years. Of the 107 cases identified, 97 individuals were retained for analysis; they had a mean gestational age of 31.1 (SD 2.9) weeks and a mean birth weight of 1.66 (SD 0.53) kilograms. Results: The majority of children assessed were found to have gross motor outcomes in the average range. Children with scores below the average range were most often born very preterm (VPT) or moderately preterm (MPT), with very low or low birth weight, respectively. A total of 17 participants were referred to physiotherapy to address the gross motor delays identified in the follow-up programme; 14 of these 17 had previously been identified as delayed and were being monitored. Late preterm (LPT) children (n=6) were most often referred, followed by those born extremely preterm (EPT) and VPT (n=4). In total, 56 children were identified as delayed at one assessment point but were found to be within normal limits by the end of the follow-up period. Conclusion: It is important to periodically monitor premature children. A longitudinal, population-based study is also needed to provide more data on the predictors and long-term motor outcomes of MPT and LPT children.

Developmental Coordination Disorder and Its Association With Developmental Comorbidities at 6.5 Years in Apparently Healthy Children Born Extremely Preterm

IMPORTANCE

There are concerns that apparently healthy extremely preterm children face a risk of developing motor impairments, such as developmental coordination disorder.

OBJECTIVE

To evaluate the prevalence of developmental coordination disorder and associated comorbidities in a national cohort of apparently healthy children born at 22 to 26 gestational weeks, compared alongside term-born peers.

DESIGN, SETTING, AND PARTICIPANTS

This prospective, population-based cohort study included all children who were consecutively born at 22 to 26 gestational weeks in Sweden from April 1, 2004, through March 31, 2007. At 6.5 years, 441 preterm children were evaluated alongside 371 controls. A total of 275 preterm children (62.4%) and 359 term-born children (96.8%) did not have neurodevelopmental disabilities. Motor assessments were completed for 229 of 275 preterm children (83.3%) and 344 of 359 (95.8%) term-born children, who composed the final study sample.

MAIN OUTCOMES AND MEASURES

Developmental coordination disorder was defined as a score of the fifth percentile or lower on the Movement Assessment Battery for Children-Second Edition scale, using control group scores. Assessment tools included the Wechsler Intelligence Scale for Children-Fourth Edition, the Brown Attention-Deficit Disorder Scales, the Five to Fifteen questionnaire, and the Strengths and Difficulties questionnaire.

RESULTS

Of the 229 extremely preterm children and 344 term-born controls who underwent motor assessments, 115 (50.2%) and 194 (56.4%) were boys, respectively. Developmental coordination disorder was present in 85 of 229 (37.1%) preterm children and in 19 of 344 controls (5.5%) (adjusted odds ratio [OR], 7.92; 99% CI, 3.69-17.20). When preterm children with developmental coordination disorder were compared with term-born peers, the risk was increased for total behavioral problems, internalizing, externalizing, attentional problems, hyperactivity, perceptual problems, executive dysfunction, and poor social skills, with adjusted ORs varying from 2.66 (99% CI, 1.09-6.48) for time concepts to 9.06 (99% CI, 3.60-22.8) for attentional problems (all P < .01). When preterm children with and without developmental coordination disorder were compared, preterm children with developmental coordination disorder had more behavioral problems; the adjusted OR for total behavioral problems was 2.71 (99% CI, 1.15-6.37); for externalizing problems, 2.80 (99% CI, 1.10-7.12); for inattention, 3.38 (99% CI, 1.39-8.18); and for combined attention/hyperactivity problems, 3.68 (99% CI, 1.47-9.16) (all P < .01). Parents underestimated the children's motor problems and only a few of the children had received psychological care or physiotherapy.

CONCLUSIONS AND RELEVANCE

Children who were born extremely preterm faced a high risk for developmental coordination disorder with associated comorbidities. Our findings support the importance of a structured follow-up of motor function, behavior, and cognition.

Neuromotor Development of Children Aged 6 and 7 Years Born before the 30th Week Gestation

Introduction

The aim of this study was to evaluate and compare the level of neuromotor function and somatic development in 6- and 7-year-old children born before the 30th week gestation with that in full-term children at the same age, as well as the correlation between prematurity and motor development.

Material and Methods

The study group consisted of prematurely born 40 children. Their mean gestational age at birth was 27.8 ± 1.6 weeks (range 24–30 weeks). The control group consisted of 40 healthy children born with normal birth weight (>2500 g). The neuromotor function was assessed using Touwen neurological examination criteria. During the examination, the attention was focused on the hand preference, laterality, synkinesis, and asymmetry. In addition, children's weight, height, and BMI index were measured.

Results

Premature children showed much worse results than full-term ones in hand function (p < 0,001). They obtained the best results in paper tearing while crossing the body midline turned out to be the most difficult. Considering the quality of walking, the biggest difficulty for the premature children was to walk backwards along the straight line while during normal walking they showed the best results. The results for the muscle tone subcategory in the study group were also significantly worse than those in control group (p < 0,001), as well as the total outcome for the movement coordination and diadochokinesis subcategories (p < 0,001).

Conclusion

The nondisabled, prematurely born children have significantly lower average outcomes regarding hand function, quality of walking, muscle tone, coordination, and diadochokinesis at age of six to seven, compared to the full-term peers.

Do Infants Born Very Premature and Who Have Very Low Birth Weight Catch Up With Their Full Term Peers in Their Language Abilities by Early School Age?

PURPOSE

This study examined the extent to which children born preterm (< 37 weeks) and/or who have low birth weight (< 2,500 g) catch up with their full term peers in terms of their language abilities at early school age (≥ 5 to < 9 years).

METHOD

A systematic literature search identified empirical studies that fit the inclusion criteria. Data from the tests/questionnaires used for meta-analysis spanned the following language categories: total language score, expressive language, receptive language, pragmatics, phonological awareness, and grammar. The means (standard deviations) were extracted from the studies and were converted to mean difference and 95% confidence intervals to test for overall effect.

RESULTS

Sixteen studies met the inclusionary criteria, for a total of 2,739 participants, of which 1,224 were born full term and 1,515 were born preterm. It is important to note that the preterm cohort represented very preterm infants who have a very low birth weight. The meta-analysis found that preterm infants scored significantly worse on total language (p < .001), receptive language (p < .001), expressive language (p < .001), phonological awareness (p < .001), and grammar (p = .03) than their full term peers. However, preterm infants did not score significantly worse than their peers on their pragmatics (p = .19).

CONCLUSIONS

Children born VPT and who have VLBW perform worse than their peers on their total language, receptive language, expressive language, phonological awareness, and grammar abilities by early school age. This information is important for speech-language pathologists to consider as children born prematurely reach school age.

Very low birth weight is associated with brain structure abnormalities and cognitive function impairments: A systematic review

Very low birth weight (VLBW) children are at risk of structural brain abnormalities and neurocognitive deficits. Since survival rate of the very low birth weight infants has increased over the past decade, a better understanding of the long-term neurocognitive outcomes is needed. The present systematic review investigated the association between VLBW and cognitive function as well as brain structure. PubMed/Medline, Google Scholar, Scopus and Web of Science databases were searched up from January 2000 to January 2015. The study was restricted to the articles that were about VLBW and its association with cognitive function and brain structure. The initial search yielded 721 articles. There were 44 studies eligible for inclusion after applying the exclusion criteria: 24 follow-up, 14 cohort, and 6 longitudinal studies. Based on this systematic review, we suggest that VLBW is positively related to several cognitive problems and brain structure abnormalities. These findings provide evidence about the importance of early assessment of cognitive development and brain structure to identify at-risk children and provide their specific requirements as early as possible.

The level of physical fitness in children aged 6-7years with low birthweight

BACKGROUND

Level of physical fitness is related to the functional status of most of the bodily functions and so it appears to be very important to identify perinatal factors influencing physical fitness.

AIM

The purpose of this study was to determine the influence of birth weight on the level of physical fitness in children 6-7years of age.

SUBJECTS AND METHOD

Physical fitness was assessed using EUROFIT tests in 28,623 children, aged 6-7years, from rural areas in Poland. Children below the 10th percentile for birth weight for gestational age were defined as small for gestational age (SGA). The influence of birth weight on parameters of fitness was assessed by means of covariance analysis.

RESULTS

With the controls of age, sex and body size, children of low birth weight have shown significantly lower levels of body flexibility and running speed. The leg strength of children with SGA turned out to be significantly lower only in 7-year-old boys.

CONCLUSION

This study has revealed the significant influence of birth weight on physical fitness. The results suggest the importance of early intervention and its possible benefits for developing and maintaining the proper level of physical fitness further in life.

Social Cognition in Children Born Preterm: A Perspective on Future Research Directions

Preterm birth is a major risk factor for children’s development. It affects children’s cognitive and intellectual development and is related to impairments in IQ, executive functions, and well-being, with these problems persisting into adulthood. While preterm children’s intellectual and cognitive development has been studied in detail, their social development and social-cognitive competencies have received less attention. Namely, preterm children show problems in interactions with others. These interaction problems are present in relationships with parents, teachers, and peers. Parents’ behavior has been identified as a possible mediator of children’s social behavior. Maternal sensitivity and responsiveness as well as absence of mental disorders foster children’s social development. In this article, we will report on the social side of impairments that preterm children face. The review of the literature revealed that preterm infants’ joint attention abilities are impaired: They are less likely to initiate joint attention with others and to respond to others’ efforts to engage in joint attention. These deficits in joint attention might contribute to later impairments in social cognition, which in turn might affect social interaction skills. Based on these three domains (i.e., problems in social interaction, parental behavior, and impairments in joint attention), we suggest that preterm children’s social cognitive abilities should be investigated more intensively.

Enhancing sensory experiences for very preterm infants in the NICU: an integrative review

OBJECTIVE

Very preterm infants hospitalized in the neonatal intensive care unit (NICU) experience alterations in sensory experiences. Defining types, timing and frequency of sensory-based interventions that optimize outcomes can inform environmental modifications. The objective of this study was to conduct an integrative review on sensory-based interventions used with very preterm infants in the NICU to improve infant and parent outcomes.

STUDY DESIGN

The data sources include MEDLINE, CINAHL, Cochrane Library and Google Scholar. Studies were identified that used sensory-based interventions in the NICU with preterm infants born ⩽32 weeks gestation, were published in a peer-reviewed journal between 1995 and 2015, and measured outcomes related to infant and parent outcomes. Studies were extracted from electronic databases and hand-searched from identified reference lists.

RESULTS

Eighty-eight articles were identified (31 tactile, 12 auditory, 3 visual, 2 kinesthetic, 2 gustatory/olfactory and 37 multimodal). There was evidence to support the use of kangaroo care, music and language exposure, and multimodal interventions starting at 25 to 28 weeks postmenstrual age. These interventions were related to better infant development and lower maternal stress, but not all findings were consistent. Limitations included lack of consistent outcome measures, study quality and gaps in the literature.

CONCLUSIONS

Most research identified interventions that were done for short periods of time. It is unclear what the potential is for improving outcomes if positive sensory exposures occur consistently throughout NICU hospitalization. Until more research defines appropriate sensory-based interventions to use with infants born very preterm in the NICU, information from this review can be combined with expert opinion and parent/family values to determine best practice.

Physical and Mental Health of Children with Developmental Coordination Disorder

Developmental coordination disorder (DCD) is a neurodevelopmental condition characterized by poor motor proficiency that interferes with an individual’s activities of daily living. These problems in motor coordination are prevalent despite children’s intelligence levels. Common symptoms include marked delays in achieving motor milestones and clumsiness, typically associated with poor balance, coordination, and especially handwriting skills. Currently, DCD is said to impact about 2–7% of school-age children. More importantly, DCD is considered to be one of the major health problems among school-aged children worldwide, with unique consequences to physical and mental health. Because these children and adolescents often experience difficulties participating in typical childhood activities (e.g., riding a bike), they tend to be more sedentary, more overweight/obese, at a higher risk for coronary vascular disease, and have lower cardiorespiratory and physical fitness than their typically developing peers. From another perspective, the motor difficulties have also been linked to an increased risk for mental health issues, such as higher anxiety and depression. The understanding of the health consequences associated with DCD offers practical applications for the understanding of the mechanisms and intervention protocols that can improve the consequences of this condition. In this review, I will explore such consequences and provide evidence for the implementation of interventions that focus on improving physical and mental health in this population.

Antepartum Bed Rest: Maternal Weight Change and Infant Birth Weight

Despite lack of evidence for effectiveness, obstetricians in the United States prescribe antepartum bed rest for more than 700,000 women per year. However, in nonpregnant samples, bed rest treatment produces weight loss. This study assessed maternal weight change (gain) during antepartum hospitalization for bed rest treatment; compared appropriateness of infant birth weights for gestational age, race, and gender; and determined whether maternal weight change predicted infant birth weight. The convenience sample for this longitudinal study consisted of 141 women with high-risk pregnancies who were treated with hospital bed rest. Weekly rate of pregnancy weight change by body mass index was compared with Institute of Medicine recommendations for rate of pregnancy weight gain. Infant birth weight was compared with current US infant birth weights for matching gestational age, gender, and race. Weekly antepartum weight change was significantly lower than Institute of Medicine recommendations (P < 0.001). Infant birth weights were also significantly lower than the national mean when matched for each infant’s gestational age, race, and gender ( P < 0.001). Maternal weight change predicted infant birth weight ( P = 0.05). Bed rest treatment is ineffective for improving pregnancy weight gain. Lower infant birth weights across all gestational ages suggest that maternal weight loss during bed rest may be associated with an increased risk of fetal growth restriction. A randomized trial comparing women with high-risk pregnancies who are ambulatory with those on bed rest is needed to determine whether bed rest treatment, underlying maternal-fetal disease, or both influence inadequate maternal weight gain and poor intrauterine growth.

Functional Connectivity of the Infant Human Brain: Plastic and Modifiable

Infancy is a critical and immensely important period in human brain development. Subtle changes during this stage may be greatly amplified with the unfolding of different developmental processes, exerting far-reaching consequences. Studies of the structure and behavioral manifestations of the infant brain are fruitful. However, the specific functional brain mechanisms that enable the execution of different behaviors remained elusive until the advent of functional connectivity fMRI (fcMRI), which provides an unprecedented opportunity to probe the infant functional brain development in vivo. Since its inception, a burgeoning field of infant brain functional connectivity study has emerged and thrived during the past decade. In this review, we describe (1) findings of normal development of functional connectivity networks and their relationships to behaviors and (2) disruptions of the normative functional connectivity development due to identifiable genetic and/or environmental risk factors during the first 2 years of human life. Technical considerations of infant fcMRI are also provided. It is our hope to consolidate previous findings so that the field can move forward with a clearer picture toward the ultimate goal of fcMRI-based objective methods for early diagnosis/identification of risks and evaluation of early interventions to optimize developing functional connectivity networks in this critical developmental window.

Low birth weight, very low birth weight and extremely low birth weight in African children aged between 0 and 5 years old: a systematic review

Low birth weight (LBW<2500), very low birth weight (VLBW<1500), extremely low birth weight (ELBW<1500) infants are at high risk for growth failure that result in delayed development. Africa is a continent that presents high rates of children born with LBW, VLBW and ELBW particularly sub-Saharan Africa. To review the existing literature that explores the repercussions of LBW, VLBW and ELBW on growth, neurodevelopmental outcome and mortality in African children aged 0–5 years old. A systematic review of peer-reviewed articles using Academic Search Complete in the following databases: PubMed, Scopus and Scholar Google. Quantitatives studies that investigated the association between LBW, VLBW, ELBW with growth, neurodevelopmental outcome and mortality, published between 2008 and 2015 were included. African studies with humans were eligible for inclusion. From the total of 2205 articles, 12 articles were identified as relevant and were subsequently reviewed in full version. Significant associations were found between LBW, VLBW and ELBW with growth, neurodevelopmental outcome and mortality. Surviving VLBW and ELBW showed increased risk of death, growth retardation and delayed neurodevelopment. Post-neonatal interventions need to be carried out in order to minimize the short-term effects of VLBW and ELBW.

PPREMO: a prospective cohort study of preterm infant brain structure and function to predict neurodevelopmental outcome

BACKGROUND

More than 50 percent of all infants born very preterm will experience significant motor and cognitive impairment. Provision of early intervention is dependent upon accurate, early identification of infants at risk of adverse outcomes. Magnetic resonance imaging at term equivalent age combined with General Movements assessment at 12 weeks corrected age is currently the most accurate method for early prediction of cerebral palsy at 12 months corrected age. To date no studies have compared the use of earlier magnetic resonance imaging combined with neuromotor and neurobehavioural assessments (at 30 weeks postmenstrual age) to predict later motor and neurodevelopmental outcomes including cerebral palsy (at 12-24 months corrected age). This study aims to investigate i) the relationship between earlier brain imaging and neuromotor/neurobehavioural assessments at 30 and 40 weeks postmenstrual age, and ii) their ability to predict motor and neurodevelopmental outcomes at 3 and 12 months corrected age.

METHODS/DESIGN

This prospective cohort study will recruit 80 preterm infants born ≤ 30 week's gestation and a reference group of 20 healthy term born infants from the Royal Brisbane & Women's Hospital in Brisbane, Australia. Infants will undergo brain magnetic resonance imaging at approximately 30 and 40 weeks postmenstrual age to develop our understanding of very early brain structure at 30 weeks and maturation that occurs between 30 and 40 weeks postmenstrual age. A combination of neurological (Hammersmith Neonatal Neurologic Examination), neuromotor (General Movements, Test of Infant Motor Performance), neurobehavioural (NICU Network Neurobehavioural Scale, Premie-Neuro) and visual assessments will be performed at 30 and 40 weeks postmenstrual age to improve our understanding of the relationship between brain structure and function. These data will be compared to motor assessments at 12 weeks corrected age and motor and neurodevelopmental outcomes at 12 months corrected age (neurological assessment by paediatrician, Bayley scales of Infant and Toddler Development, Alberta Infant Motor Scale, Neurosensory Motor Developmental Assessment) to differentiate atypical development (including cerebral palsy and/or motor delay).

DISCUSSION

Earlier identification of those very preterm infants at risk of adverse neurodevelopmental and motor outcomes provides an additional period for intervention to optimise outcomes.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12613000280707. Registered 8 March 2013.

Motor Coordination Difficulties in Extremely Low Birth Weight Survivors Across Four Decades

OBJECTIVE

To compare levels of motor coordination difficulties in a cohort of extremely low birth weight (ELBW; <1000 g) survivors and normal birth weight (NBW) controls from childhood until age 36. The stability of motor coordination in ELBW and NBW adults from their 20s to their 30s was also assessed.

METHODS

This study uses a prospectively followed population-based birth cohort of ELBW survivors born between 1977 and 1982 in Ontario, Canada, to compare motor coordination at age 8, age 22 to 26, and age 29 to 36 in ELBW survivors relative to a matched group of NBW controls across a number of different measures.

RESULTS

After adjusting for neurosensory impairment, ELBW survivors had significantly higher levels of motor coordination difficulties than their NBW counterparts at age 8, 22 to 26, and 29 to 36. Self-reported motor coordination remained relatively stable from age 22 to 26 to age 29 to 36 in both groups.

CONCLUSIONS

ELBW survivors display higher levels of motor coordination difficulties than NBW controls in childhood through their mid 30s. Motor coordination seems to be stable from age 22 to 36 in both groups, suggesting that the presence of motor problems in ELBW survivors can have important implications for functional outcomes in adulthood.

Automatic segmentation of the hippocampus for preterm neonates from early-in-life to term-equivalent age

Introduction

The hippocampus, a medial temporal lobe structure central to learning and memory, is particularly vulnerable in preterm-born neonates. To date, segmentation of the hippocampus for preterm-born neonates has not yet been performed early-in-life (shortly after birth when clinically stable). The present study focuses on the development and validation of an automatic segmentation protocol that is based on the MAGeT-Brain (Multiple Automatically Generated Templates) algorithm to delineate the hippocampi of preterm neonates on their brain MRIs acquired at not only term-equivalent age but also early-in-life.

Methods

First, we present a three-step manual segmentation protocol to delineate the hippocampus for preterm neonates and apply this protocol on 22 early-in-life and 22 term images. These manual segmentations are considered the gold standard in assessing the automatic segmentations. MAGeT-Brain, automatic hippocampal segmentation pipeline, requires only a small number of input atlases and reduces the registration and resampling errors by employing an intermediate template library. We assess the segmentation accuracy of MAGeT-Brain in three validation studies, evaluate the hippocampal growth from early-in-life to term-equivalent age, and study the effect of preterm birth on the hippocampal volume. The first experiment thoroughly validates MAGeT-Brain segmentation in three sets of 10-fold Monte Carlo cross-validation (MCCV) analyses with 187 different groups of input atlases and templates. The second experiment segments the neonatal hippocampi on 168 early-in-life and 154 term images and evaluates the hippocampal growth rate of 125 infants from early-in-life to term-equivalent age. The third experiment analyzes the effect of gestational age (GA) at birth on the average hippocampal volume at early-in-life and term-equivalent age using linear regression.

Results

The final segmentations demonstrate that MAGeT-Brain consistently provides accurate segmentations in comparison to manually derived gold standards (mean Dice's Kappa > 0.79 and Euclidean distance <1.3 mm between centroids). Using this method, we demonstrate that the average volume of the hippocampus is significantly different (p < 0.0001) in early-in-life (621.8 mm³) and term-equivalent age (958.8 mm³). Using these differences, we generalize the hippocampal growth rate to 38.3 ± 11.7 mm³/week and 40.5 ± 12.9 mm³/week for the left and right hippocampi respectively. Not surprisingly, younger gestational age at birth is associated with smaller volumes of the hippocampi (p = 0.001).

Conclusions

MAGeT-Brain is capable of segmenting hippocampi accurately in preterm neonates, even at early-in-life. Hippocampal asymmetry with a larger right side is demonstrated on early-in-life images, suggesting that this phenomenon has its onset in the 3rd trimester of gestation. Hippocampal volume assessed at the time of early-in-life and term-equivalent age is linearly associated with GA at birth, whereby smaller volumes are associated with earlier birth.

•

We develop a MAGeT-Brain based automatic protocol to segment hippocampus in preterm neonates.

•

MAGeT-Brain can accurately segment hippocampus in preterm neonates, even at early-in-life.

•

Hippocampal asymmetry with a larger right side is demonstrated on early-in-life images.

•

Smaller hippocampal volumes are associated with earlier birth in preterm neonates.

Motor coordination and mental health in extremely low birth weight survivors during the first four decades of life

The co-morbidity of motor coordination and mental health problems is an increasing concern. While links between poor motor coordination and mental health have been examined extensively in individuals born at normal birth weight (NBW; >2500g), relatively little research has examined these associations in special populations, particularly those born at extremely low birth weight (ELBW; <1000g). In this study, we examined whether birth weight status (ELBW vs. NBW) moderated associations between motor coordination problems and levels of mental health problems from childhood into the fourth decade of life. The present study utilized the oldest known prospectively followed, population-based cohort of ELBW survivors (n=151). This group was born between 1977 and 1982 in Ontario, Canada and was compared to a matched group of NBW controls (n=145). Mental health problems were measured at age 8 using parent and teacher reports, and at age 22-26 and 29-36 using self-reports. Childhood motor coordination was retrospectively reported at age 29-36. In both ELBW and NBW groups, childhood coordination problems were associated with elevated levels of inattention and symptoms of anxiety and depression. However, we observed stronger associations between childhood motor coordination problems and mental health problems in NBW controls at 22-26 and 29-36 years of age than in ELBW survivors. Our findings highlight the importance of recognizing and screening for motor coordination problems not only in vulnerable, at-risk children, but in all children, as motor difficulties appear to be associated with mental health problems well into adult life.

Resting-State Network Complexity and Magnitude Are Reduced in Prematurely Born Infants

Premature birth is associated with high rates of motor and cognitive disability. Investigations have described resting-state functional magnetic resonance imaging (rs-fMRI) correlates of prematurity in older children, but comparable data in the neonatal period remain scarce. We studied 25 term-born control infants within the first week of life and 25 very preterm infants (born at gestational ages ranging from 23 to 29 weeks) without evident structural injury at term equivalent postmenstrual age. Conventional resting-state network (RSN) mapping revealed only modest differences between the term and prematurely born infants, in accordance with previous work. However, clear group differences were observed in quantitative analyses based on correlation and covariance matrices representing the functional MRI time series extracted from 31 regions of interest in 7 RSNs. In addition, the maximum likelihood dimensionality estimates of the group-averaged covariance matrices in the term and preterm infants were 5 and 3, respectively, indicating that prematurity leads to a reduction in the complexity of rs-fMRI covariance structure. These findings highlight the importance of quantitative analyses of rs-fMRI data and suggest a more sensitive method for delineating the effects of preterm birth in infants without evident structural injury.

Expression of hypoxia-inducible factor 1 alpha and oligodendrocyte lineage gene-1 in cultured brain slices after oxygen-glucose deprivation

Oligodendrocyte lineage gene-1 expressed in oligodendrocytes may trigger the repair of neuronal myelin impairment, and play a crucial role in myelin repair. Hypoxia-inducible factor 1α, a transcription factor, is of great significance in premature infants with hypoxic-ischemic brain damage. There is little evidence of direct regulatory effects of hypoxia-inducible factor 1α on oligodendrocyte lineage gene-1. In this study, brain slices of Sprague-Dawley rats were cultured and subjected to oxygen-glucose deprivation. Then, slices were transfected with hypoxia-inducible factor 1α or oligodendrocyte lineage gene-1. The expression levels of hypoxia-inducible factor 1α and oligodendrocyte lineage gene-1 were significantly up-regulated in rat brains prior to transfection, as detected by immunohistochemical staining. Eight hours after transfection of slices with hypoxia-inducible factor 1α, oligodendrocyte lineage gene-1 expression was upregulated, and reached a peak 24 hours after transfection. Oligodendrocyte lineage gene-1 transfection induced no significant differences in hypoxia-inducible factor 1α levels in rat brain tissues with oxygen-glucose deprivation. These experimental findings indicate that hypoxia-inducible factor 1α can regulate oligodendrocyte lineage gene-1 expression in hypoxic brain tissue, thus repairing the neural impairment.

The prenatal, perinatal and neonatal risk factors for children's developmental coordination disorder: a population study in mainland China

We initially conducted a population-based study on developmental coordination disorder (DCD) in mainland China to explore the prenatal, perinatal and neonatal risk factors on DCD. A total of 4001 children were selected from 160 classes in 15 public nursery schools. The Movement Assessment Battery for Children-Second Edition (MABC-2) was used to assess the children's motor function. Crude and adjusted odds ratios were estimated to determine the strength of association using a multilevel logistic regression model with a random intercept. Three hundred and thirty children out of 4001 subjects met the DSM-IV criteria for DCD, and 3671 children were non-DCD. Maternal age, threatened abortion, fetal distress during labor, preterm birth, chronic lung disease and newborn pathological jaundice were related with DCD (OR=1.72, 2.72, 9.14, 5.17, 1.43, and 2.54, respectively, each p<0.05). Considered collectively, these risk factors may provide clues to an etiology of DCD. Additionally, the practitioners of maternity and child health care should improve the assessment and monitoring of the prenatal, perinatal and neonatal risk factors for DCD.

Regional white matter microstructure in very preterm infants: predictors and 7 year outcomes

The aims of this study were to investigate regional white matter microstructural differences between very preterm (VPT) (<30 weeks' gestational age and/or <1250 g) and full term (FT) (≥37 weeks' gestational age) infants at term corrected age with diffusion tensor imaging, and to explore perinatal predictors of diffusion measures, and the relationship between regional diffusion measures and neurodevelopmental outcomes at age 7 years in VPT children. Mean (MD) (p = .003), axial (AD) (p = .008), and radial diffusivity (RD) (p = .003) in total white matter were increased in VPT compared with FT infants, with similar fractional anisotropy (FA) in the two groups. There was little evidence that group-wise differences were specific to any of the 8 regions studied for each hemisphere. Perinatal white matter abnormality and intraventricular hemorrhage (grade III or IV) were associated with increased diffusivity in the white matter of VPT infants. Higher white matter diffusivity measures of the inferior occipital and cerebellar region at term-equivalent age were associated with increased risk of impairments in motor and executive function at 7 years in VPT children, but there was little evidence for associations with IQ or memory impairment. In conclusion, myelination is likely disrupted or delayed in VPT infants, especially those with perinatal brain abnormality (BA). Altered diffusivity at term-equivalent age helps explain impaired functioning at 7 years. This study defines the nature of microstructural alterations in VPT infant white matter, assists in understanding the associated risk factors, and is the first study to reveal an important link between inferior occipital and cerebellar white matter disorganization in infancy, and executive and motor functioning 7 years later.

Behavior and well-being of extremely low birth weight teenagers in Iceland

BACKGROUND

Preterm children are at risk for behavioral and emotional problems.

AIMS

To evaluate behavior and emotional well-being of extremely low birth weight (ELBW) teenagers born in Iceland in 1991-1995.

METHODS

Participants, 30 of 35 ELBW survivors (25 girls, 5 boys, mean age 16.8 years), were interviewed, underwent medical examination and answered the Youth Self-Report for ages 11-18 (YSR) of the Achenbach System of Empirically Based Assessment (ASEBA). The ELBW parents answered the ASEBA Child Behavior Checklist for ages 6-18 and the Autism Spectrum Screening Questionnaire (ASSQ). A comparison group of 30 teenagers (23 girls, 7 boys, mean age 16.5 years) answered the YSR questionnaire and their parents answered the CBCL and ASSQ questionnaires.

RESULTS

ELBW teenagers and parents report more behavior problems than the full term comparison teenagers and parents. They score significantly higher on the YSR and CBCL syndrome scales except for YSR and CBCL rule-breaking behavior and CBCL thought problems. The ELBW teenagers self-report on total competence, activities, social participation and academic performance was not significantly lower than the comparison teenagers. Parents of ELBW teenagers rated total competence, social participation and school performance of their children significantly lower than parents of comparison teenagers. The YSR Positive Qualities Scale was not significantly different between the two teenage groups. Two ELBW teenagers scored above cut-off points on the ASSQ questionnaire and none of the comparison teenagers. Bullying was reported by 20% of ELBW parents compared to none of the comparison group.

CONCLUSION

ELBW teenagers experience emotional, behavior and social challenges. The teenagers value their positive qualities, activities and academic performance similar to peers.

Treadmill training in moderate risk preterm infants promotes stepping quality--results of a small randomised controlled trial

Infants at risk for neuromotor delay (NMD) are associated with premature birth and low birth weight. These infants frequently exhibit tone, posture, and movement abnormalities. Therefore, it is important to identify potential interventions to facilitate early motor development within this population. The purpose of this study was to examine the potential benefits of treadmill (TM) training in infants at risk for NMD. Furthermore, relationships between TM stepping performance and onset of walking have been suggested, and therefore, were also explored. Twenty-eight infants at moderate risk for NMD were randomly assigned to one of two groups: (1) TM training (experimental) (N=15) or (2) control (N=13). Infants in the experimental group were trained for 8 min/day, five days/week from study entry until walking onset. Monthly, 5 min of TM stepping performance were videotaped and analysed for infants in both groups to obtain frequency and quality of TM stepping. Groups were different in terms of TM stepping performance with experimental group displaying better stepping. However, they did not differ in age of walking onset (experimental=15.1 months, control=14.6 months). In both groups, frequency of TM stepping was significantly related to onset of walking. Findings suggest that TM training as implemented impact the quality of TM stepping, but did not significantly improve walking onset. Given the significant relationship between stepping and walking onset, the moderate affection of the population, the relative low intensity and lack of individualisation of the training, we suggest future research should further explore the impact of TM training on gait-related variables and include individualised, more intense, and prolonged training.

Understanding physical activity and motivations for children with developmental coordination disorder: an investigation using the theory of planned behavior

Developmental coordination disorder (DCD) is a neurodevelopmental condition, affecting approximately 5-6% of children. Previous research has consistently found children with DCD being less physically active compared to typically-developing (TD) children; however, the psychosocial factors associated with physical activity for children with DCD are poorly understood. The purpose of this study was to examine how theory-based physical activity cognitions impacts physical activity behaviors for children with and without DCD. Participants included a sample of boys (N=61, Mage=13.25 ±.46) with DCD (n=19) and without DCD (n=42), drawn from a larger prospective cohort study. A questionnaire with psychosocial measures was first administered, and accelerometers were used to assess their physical activity behavior over the subsequent week. Findings indicate that DCD was significantly associated with lower physical activity (F(1,58)=6.51, p<.05), and poorer physical activity cognitions (F(4,56) Wilks Lambda=2.78, p<.05). Meditational analyses found attitudes (B=.23, p<.05) and subjective norms (B=.31, p<.05) partially mediating the relationship between DCD and physical activity. Overall, this study further confirms that the activity deficit that exists among boys with DCD, and that the relationship is partially mediated through some physical activity cognitions. Interventions should target the perceived approval of influential people, and the personal evaluations of physical activity for boys with motoric difficulties. These findings further emphasizes the discrepancy in physical activity that exist between boys with DCD and TD boys, and highlight the need to better understand the psychological factors related to physical activity for children with DCD.

Developmental expression of N-methyl-D-aspartate (NMDA) receptor subunits in human white and gray matter: potential mechanism of increased vulnerability in the immature brain

The pathophysiology of perinatal brain injury is multifactorial and involves hypoxia-ischemia (HI) and inflammation. N-methyl-d-aspartate receptors (NMDAR) are present on neurons and glia in immature rodents, and NMDAR antagonists are protective in HI models. To enhance clinical translation of rodent data, we examined protein expression of 6 NMDAR subunits in postmortem human brains without injury from 20 postconceptional weeks through adulthood and in cases of periventricular leukomalacia (PVL). We hypothesized that the developing brain is intrinsically vulnerable to excitotoxicity via maturation-specific NMDAR levels and subunit composition. In normal white matter, NR1 and NR2B levels were highest in the preterm period compared with adult. In gray matter, NR2A and NR3A expression were highest near term. NR2A was significantly elevated in PVL white matter, with reduced NR1 and NR3A in gray matter compared with uninjured controls. These data suggest increased NMDAR-mediated vulnerability during early brain development due to an overall upregulation of individual receptors subunits, in particular, the presence of highly calcium permeable NR2B-containing and magnesium-insensitive NR3A NMDARs. These data improve understanding of molecular diversity and heterogeneity of NMDAR subunit expression in human brain development and supports an intrinsic prenatal vulnerability to glutamate-mediated injury; validating NMDAR subunit-specific targeted therapies for PVL.

Relations among upper-limb movement organization and cognitive function at school age in children born preterm

OBJECTIVE

To explore relations between aspects of upper-body spatiotemporal movement organization and intelligence in children born preterm at school age.

METHODS

Three-dimensional (3D) kinematic recordings of arm and head movements during a unimanual precision task were related to performance on the Wechsler Intelligence Scale for Children, 4th edition, in a sample of 32 children born preterm (gestational age, mean: 31.5 weeks [range: 22-35 weeks]; birth weight, mean: 1699 g [range: 404-2962 g]) at 6 years to 8 years with no diagnosed cognitive, sensory, or motor impairments compared with 40 age-matched control children born fullterm.

RESULTS

In the children born preterm, upper-limb movement duration and segmentation of movement trajectories were significantly associated with full-scale intelligence quotient independent of gestational age (GA) and sex. These effects pertained to the preferred side, characterized by more effective movement organization being linked with increased intelligence scores. The same relations were not seen in the controls. Within the children born preterm, a significant effect of GA was also found for some aspects of upper-limb movement organization. Full-scale intelligence quotient was within normal limits for both groups but significantly lower in the preterm (mean: 94.5 [range: 72-120]) compared with the fullterm (mean: 101.7 [range: 76-119]) born children.

CONCLUSIONS

The findings demonstrate that, independent of GA, the spatiotemporal organization of upper-limb movements is partly associated with cognitive performance in children born preterm.

Biomarkers of brain damage in preterm infants

OBJECTIVE

There is growing evidence on the usefulness of biomarkers in the early detection of preterm infants at risk for brain damage. However, among different tools Activin A, S100B protein and adrenomedullin assessment offer the possibility to investigate brain/multiorgan function and development. This could be especially useful in perinatal medicine that requires even more non-invasive techniques in order to fulfill the minimal handling in diagnostic and therapeutic strategy performance.

MATERIALS AND METHODS

The concept of Unconventional Biological Fluid (UBF: urine and saliva) is becoming even stronger and regards the assessment in non-invasive biological fluids of biochemical markers involved in the cascade of events leading to brain damage.

RESULTS

Activin A, S100B protein and adrenomedullin in UBF were increased in preterm newborns developing brain damage and/or ominous outcome.

CONCLUSIONS

The present manuscript offers an update on the usefulness of Activin A, S100B protein an adrenomedullin in UBF as brain damage markers. The findings open a new cue on the use of these markers in daily neonatal intensive care unit (NICU) activities.

Maturation of corpus callosum anterior midbody is associated with neonatal motor function in eight preterm-born infants

Background. The etiology of motor impairments in preterm infants is multifactorial and incompletely understood. Whether corpus callosum development is related to impaired motor function is unclear. Potential associations between motor-related measures and diffusion tensor imaging (DTI) of the corpus callosum in preterm infants were explored. Methods. Eight very preterm infants (gestational age of 28–32 weeks) underwent the Hammersmith neonatal neurological examination and DTI assessments at gestational age of 42 weeks. The total Hammersmith score and a motor-specific score (sum of Hammersmith motor subcategories) were calculated. Six corpus callosum regions of interest were defined on the mid-sagittal DTI slice—genu, rostral body, anterior midbody, posterior midbody, isthmus, and splenium. The fractional anisotropy (FA) and mean diffusivity (MD) of these regions were computed, and correlations between these and Hammersmith measures were sought. Results. Anterior midbody FA measures correlated positively with total Hammersmith (rho = 0.929, P = 0.001) and motor-specific scores (rho = 0.857, P = 0.007). Total Hammersmith scores also negatively correlated with anterior midbody MD measures (rho = −0.714, P = 0.047). Discussion. These results suggest the integrity of corpus callosum axons, particularly anterior midbody axons, is important in mediating neurological functions. Greater callosal maturation was associated with greater motor function. Corpus callosum DTI may prove to be a valuable screening or prognostic marker.

Timing abilities among children with developmental coordination disorders (DCD) in comparison to children with typical development

Timing ability is essential for common everyday performance. The aim of the study was to compare timing abilities and temporal aspects of handwriting performance and relationships between these two components among children with Developmental Coordination Disorders (DCD) and a control group. Forty two children, 21 diagnosed as DCD and 21 with typical development, aged 7-12, were matched for age, gender and school performed 14 tasks of the interactive metronome (IM) and three functional handwriting tasks on an electronic tablet that was part of a computerized system (ComPET--computerized penmanship evaluation tool). The IM supplies response time, while on-paper and in-air time per written stroke is received from the ComPET. Results indicated significant differences between the groups for both IM and handwriting tasks (ComPET). Linear regression indicated that the mean IM response time explained 37% of variance of the in-air time per stroke during a paragraph-copying task. Furthermore, based on one discriminate function including two measures reflected timing ability, 81% of all participants were correctly classified into groups. Study results strongly recommend consideration of the IM as an evaluation and intervention tool for children with DCD who are faced with timing deficits in their everyday functioning.

Baixo peso ao nascer e proficiência motora em crianças: uma revisão sistemática

O objetivo deste trabalho foi analisar estudos que associam o baixo peso ao nascer e a proficiência motora em crianças com idade entre um e dez anos. A revisão sistemática da literatura foi realizada em base de dados eletrônica e lista de referência dos artigos publicados. Foram utilizados os seguintes descritores na língua inglesa: "infant low birth weight", "infant very low birth weight", "infant extremely low birth weight", "motor skills", "psychomotor performance", "child development", "human development", "growth & development", "growth" e "fetal development". A análise dos estudos envolveu leitura de títulos, resumos e textos completos. No total, 18 artigos foram lidos na íntegra; apenas dois estudos tiveram delineamento longitudinal; e os demais estudos eram transversais. As crianças avaliadas tinham idade entre 9 meses e 9 anos. Na avaliação do desenvolvimento motor, há ampla utilização de instrumentos já padronizados, que avaliam habilidades motoras grossas e finas de maneira quantitativa.Os resultados dos estudos apontam que crianças nascidas com peso abaixo de 2.500g apresentam algum tipo de deficit motor. As habilidades mais afetadas foram as habilidades motoras finas e o equilíbrio. O peso ao nascer é uma variável que deve ser considerada nos estudos sobre o desenvolvimento de habilidades motoras básicas das crianças.

Developmental coordination disorder: a review and update

Present in approximately 5-6% of school-aged children, developmental coordination disorder (DCD) is a neuromotor disability in which a child's motor coordination difficulties significantly interfere with activities of daily living or academic achievement. These children typically have difficulty with fine and/or gross motor skills, with motor performance that is usually slower, less accurate, and more variable than that of their peers. In this paper, we review the history of various definitions leading up to the current definition of DCD, prevalence estimates for the disorder, etiology, common co-morbidities, the impact of DCD on the child's life, and prognosis. As well, we briefly describe current interventions for children with the disorder and results of recent neuroimaging studies of the brains of children with DCD, including research by the authors of this paper.

Motor coordination impairment and migraine in children: a new comorbidity?

Migraine without aura (MoA) could be considered the most frequent form of primary headache in children, associated with many known comorbidities, but only the recent literature has begun to consider the importance of motor impairment linked to the attacks. The developmental coordination disorder (DCD) is a very common problem among children, with a prevalence ranging up to 19 %. The aim of this study was to evaluate the presence of motor coordination impairment in a population of children affected by MoA, and its role as putative risk factor for motor skills impairment. This observational study was performed in the Clinic of Child and Adolescent Neuropsychiatry of the Second University of Naples. MoA was diagnosed according to the International Classification of Headache Disorders (IHS-2) criteria. The study population consisted of 27 patients affected by MoA (16 females, 11 males) (mean age: 8.7 ± 2.15 years) and 59 typically developing children (34 females, 25 males) (mean age: 8.0 ± 2.1 years). The whole population underwent a clinical evaluation in order to assess the total IQ level, the visual motor integration skills, and the presence of DCD. Our results showed that MoA children had more impairments in motor coordination (p < 0.001) and visual motor integration (p < 0.001) than control group. To our knowledge, this is the first study to assess the association of poor motor coordination and MoA in children using objective measurements. These findings suggest a new perspective in the management of migraine disease in children, pinpointing that the relationship between DCD and migraine could represent a not yet understood or identified comorbidity, even if further reports are necessary, and that migraine probably could be considered not only a painful syndrome in future.

Magnetic resonance imaging of the brain at term equivalent age in extremely premature neonates: to scan or not to scan?

In the last decade, the role of magnetic resonance imaging (MRI) in neonatal care for prematurely born infants has rapidly expanded and evolved. Recent investigations addressed many of the practical issues pertaining to image acquisition and interpretation, enabling high-quality MR images to be obtained without sedating medications in preterm infants at any institution. Expanded application has demonstrated that MRI provides superior ability to assess cerebral development and identify and define cerebral injury in comparison to other imaging modalities. Term equivalent MRI results have been shown to correlate with neurodevelopmental outcomes, providing improved predictive ability over other neuroimaging, clinical or physical examination measures. Regular utilisation of MRI in this population is fundamental to gaining the knowledge and expertise necessary for rational, accurate application. Ongoing experiences will continue to shape the nature and type of information available to clinicians and families using MRI, further refining its role as a routine element of neonatal care.