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Impaired motor function (clumsiness) in 5 year old children: correlation with neonatal ultrasound scans
Insights
Very low birth weight infants show higher motor impairment and cognitive scores. Neonatal ultrasound findings like prolonged flare and germinal matrix haemorrhage-intraventricular haemorrhage are linked to motor issues, but low birth weight is the primary factor.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Pediatric neurology
Background:
- Very low birth weight (VLBW) infants face risks for developmental challenges.
- Neonatal neuroimaging, particularly ultrasound, can identify early brain abnormalities.
- Long-term neurodevelopmental outcomes require continued follow-up.
Purpose of the Study:
- To assess the long-term neurodevelopmental outcomes of VLBW infants.
- To investigate the association between neonatal ultrasound findings and 5-year motor and cognitive function.
- To determine the relative contributions of ultrasound abnormalities and VLBW to developmental outcomes.
Main Methods:
- A longitudinal cohort study followed 155 surviving VLBW infants from an original cohort of 200.
- Infants underwent serial neonatal ultrasound examinations.
- At 5 years, children were assessed using the Test of Motor Impairment (TOMI) and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) vocabulary subscale, compared to controls.
Main Results:
- VLBW children scored significantly higher on both TOMI and WPPSI compared to controls.
- Subgroup analysis based on ultrasound findings showed variations in outcomes.
- Regression analysis indicated low birth weight as a significant predictor of motor impairment, outweighing specific ultrasound findings.
Conclusions:
- VLBW infants demonstrate enhanced motor and cognitive performance at age 5, despite potential neonatal complications.
- Minor ultrasound abnormalities like prolonged flare and germinal matrix haemorrhage-intraventricular haemorrhage (GMH-IVH) are associated with motor impairment (clumsiness).
- Low birth weight is the most significant factor influencing motor impairment in this cohort, with ultrasound findings having a smaller effect.
Abstract:
All 155 surviving children from a cohort of 200 very low birthweight infants originally studied in 1984-5 were traced. These infants had careful sequential ultrasound examinations in the neonatal period. The children were examined again at entry into school at 5 years of age. The test of motor impairment (TOMI) and the vocabulary subscale of the Wechsler preschool and primary scale of intelligence (WPPSI) were administered to 152 of the index cohort and 144 control children of the same age in the same class at school. Twelve of the cohort had cerebral palsy, but eight of these were in mainstream schools. The index group scored significantly higher on both the TOMI and the WPPSI subscale compared with the controls. The index cases were subdivided on the basis of their neonatal ultrasound scans into four groups: group 1, consistently normal; group 2, 'prolonged flare'; group 3, germinal matrix haemorrhage-intraventricular haemorrhage (GMH-IVH), without parenchymal haemorrhage, but no evidence of prolonged flare; and group 4, both GMH-IVH and prolonged flare. The group of index children with consistently normal ultrasound scans had a higher TOMI and lower WPPSI compared with their controls. There was a statistically significant increase in the TOMI subscore 1 (manual dexterity) in group 4 infants compared with group 1, but not differences between the other groups. Regression analysis suggests that neither prolonged flare nor GMH-IVH has an important individual contribution to the variation, but the low birth weight does have a significant relationship with motor impairment. It appears that relatively minor ultrasound appearances such as prolonged flare and GMH-IVH are associated with motor impairment (clumsiness) at 5 years, but this has a small effect compared with low birth weight.
