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Periventricular leucomalacia and preterm birth have different detrimental effects on postural adjustments
M Hadders-Algra1, E Brogren, M Katz-Salamon
1Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden. m.hadders-algra@med.rug.nl
Insights
Preterm birth, particularly with periventricular white matter (PWM) lesions, impacts children's postural adjustments. Preterm infants exhibit altered motor control and increased sensitivity to movement, affecting their ability to maintain balance.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Motor Control
Background:
- Preterm birth is a significant risk factor for neurological and motor impairments.
- Periventricular white matter (PWM) lesions are common in preterm infants and associated with adverse neurodevelopmental outcomes.
- Understanding postural control in early childhood is crucial for identifying developmental risks.
Purpose of the Study:
- To investigate postural adjustments in preterm children with and without PWM lesions compared to full-term controls.
- To assess the impact of preterm birth and PWM lesions on motor control and balance.
- To identify specific types of postural dysfunction associated with preterm birth and brain injury.
Main Methods:
- Multiple surface electromyography (EMG) of neck, trunk, and leg muscles and kinematics were used to assess postural adjustments.
- Three groups of children (1.5–4.5 years) were studied: preterm with PWM lesions, preterm without PWM lesions (controls), and healthy full-term controls.
- Age-specific neurological examinations were conducted alongside postural assessments.
Main Results:
- Preterm birth was linked to two types of postural dysfunction: limited response variation (associated with PWM lesions) and altered modulation of postural responses (associated with preterm birth itself).
- Preterm children demonstrated higher sensitivity to platform velocity and a reduced capacity to modulate EMG amplitude based on initial sitting position compared to full-term children.
- Neurological outcomes varied, with some preterm children developing cerebral palsy or minor neurological dysfunction.
Conclusions:
- Preterm birth significantly affects postural control, with distinct dysfunctions related to white matter lesions and preterm birth independently.
- Children born preterm exhibit impaired motor modulation and increased sensitivity to external stimuli, highlighting the long-term impact of prematurity on motor development.
- Early assessment of postural adjustments can aid in identifying and managing motor deficits in preterm populations.
Abstract:
Postural adjustments during sitting on a moveable platform were assessed by means of multiple surface EMGs of neck, trunk and leg muscles and kinematics in three groups of children, aged 1 1/2-4 1/2 years. The first group consisted of 13 preterm children (born at a gestational age of 25-34 weeks), whose neonatal ultrasounds had shown distinct lesions of the periventicular white matter (PWM). The second group was the preterm control group, consisting of 13 preterm children with normal neonatal brain scans, matched to the PWM group with respect to gestational age at birth, birth weight, sex and age of postural assessment. The third group was formed by 13 healthy children born at term and matched to the PWM group with respect to sex and age at examination. In addition to the postural assessment an age-specific neurological examination was carried out. Three of the children of the PWM group developed a cerebral palsy syndrome, nine showed minor neurological dysfunction and one child was neurologically normal. In the preterm control group one child showed minor neurological dysfunction, while the remaining 12 children of this group and all children of the full-term group were neurologically normal. The postural assessment revealed that preterm birth was associated with two types of postural dysfunction. One dysfunction was related to the presence of a PWM lesion and consisted of a limited repertoire of response variation. The other dysfunction was not related to the presence of a PWM lesion, but to preterm birth itself. It consisted of a change in the ability to modulate the postural responses. Preterm children showed a higher sensitivity to platform velocity than full-term children, and they lacked the capacity to modulate EMG amplitude with respect to initial sitting position.