Health-related quality of life among five-year-old extremely preterm children with motor disorders

Background

Motor disorders resulting from extremely preterm birth (EPT; <28 weeks’ gestation) can limit daily activities, schooling and social relationships. Cerebral palsy (CP) affects about 10% of children and non-CP movement difficulties (MD) are highly prevalent, although they tend to be under-diagnosed, especially in children without other developmental difficulties. We investigated the association between motor disorders and health-related quality of life (HRQoL) among five-year-old children born EPT.

Methods

We included children at age five from a population-based EPT birth cohort born in 2011-2012 in 11 European countries (N = 1,021). Children without CP were classified using the Movement Assessment Battery for Children - 2nd edition as having significant MD (≤5th percentile of standardised norms) or being at risk of MD (6th-15th percentile). Parents reported on CP diagnoses and HRQoL using the Pediatric Quality of Life InventoryTM. We used linear regression to compare HRQoL scores by motor status adjusting for social characteristics.

Results

Children born EPT with CP, significant MD and at risk of MD had lower adjusted HRQoL total scores [95% confidence intervals] than those without MD: -26.1 [-31.0; -21.2], -9.1 [-12.0; -6.1] and -5.0 [-7.7; -2.3]. Decreases were greater for physical scores: -35.3 [-42.7; -27.9], -11.9 [-16.1; -7.8] and -5.4 [-9.1; -1.6] than psychosocial scores: -20.6 [-25.2; -16.0], -7.4 [-10.3; -4.5] and -4.9 [-7.6; -2.1]. These differences persisted after exclusion of children with other developmental difficulties.

Conclusions

Motor disorders among 5-year-old children born EPT were associated with lower HRQoL, even among children with less severe motor difficulties and without other developmental difficulties.

Key messages

[Anatomic findings during 509 microscopic sphincteroplasties for urinary stress incontinence in women. Diagnostic and surgical consequences]

Stress incontinence of urine without cervicocystoptosis secondary to difficult labor and delivery is essentially due to rupture of the smooth muscle sphincter of the bladder. Other changes affecting the anterior vaginal wall (thinning of fibrous tissue, partial splitting of the striated urethral sphincter, etc.) are found before difficult labor without stress incontinence of urine. Only operative microscopy enables anatomical analysis. Lateral cystography confirms the clinical diagnosis. There is no correlation between the extent of lesions and functional study results. Surgery is limited to the dissection and apposition of the residual zone of the smooth muscle sphincter retracted laterally. There were neither postoperative dysuria nor dyspareunia. There were 11 recurrences. No marked symptomatic change 5 years later.