Gross motor functional abilities in preterm-born children with cerebral palsy due to periventricular leukomalacia
I C van Haastert1, L S de Vries, M J C Eijsermans
1Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands. i.vanhaastert@umcutrecht.nl
Insights
Periventricular leukomalacia (PVL) grade impacts gross motor function in children with cerebral palsy. Lower PVL grades (I-II) indicate a better prognosis for functional mobility compared to higher grades (III-IV).
Area of Science:
- Neurology
- Pediatrics
- Developmental Biology
Background:
- Periventricular leukomalacia (PVL) is a significant cause of cerebral palsy (CP) in preterm infants.
- Understanding the impact of PVL severity on long-term motor function is crucial for early intervention.
Purpose of the Study:
- To investigate the association between the grade of PVL and gross motor function in children with CP.
- To evaluate the prognostic value of PVL grading for functional mobility outcomes.
Main Methods:
- A cohort of 59 children (gestational age ≤ 34 weeks) with CP due to PVL (grades I-IV) was studied.
- Gross Motor Function Classification System (GMFCS) was used by two independent raters at four time points (corrected ages 9 months to 7.5 years).
- Statistical analysis assessed interrater reliability, temporal stability, and the predictive value of PVL grade for GMFCS level.
Main Results:
- A strong association was found between PVL grade and gross motor outcome at age 7.5 years.
- Children with PVL grades I-II showed a significantly better prognosis for functional mobility than those with PVL grades III-IV.
- The stability of GMFCS levels increased over time, with 72% of children remaining in the same level from age 24 months to 7.5 years.
Conclusions:
- Neonatal PVL grading is a strong predictor of long-term gross motor function in children with CP.
- PVL grades I-II suggest a more favorable functional mobility outlook than grades III-IV.
- These findings support tailored habilitation counseling and targeted intervention strategies based on PVL severity.
Abstract:
To describe the impact of periventricular leukomalacia (PVL) on gross motor function, data on 59 children (37 males, 22 females) with a gestational age (GA) of 34 weeks or less with cerebral palsy (CP) due to PVL grade I (n=20), II (n=13), III (n=25), and IV (n=1) were studied; (mean GA 29 wk 4d [SD 4 wk 6d]; mean birthweight 1318 g [SD 342]). Two independent raters used the Gross Motor Function Classification System (GMFCS) at four time points: T1, mean corrected age (CA) 9 months 15 days (SD 2 mo 6d); T2, mean CA 16 months (SD 1 mo 27 d); T3, mean CA 24 months 27 days (SD 2 mo 3d); and T4, median age 7 years 6 months (range 2 y 2 mo-16 y 8 mo). Interrater reliability and stability across time with respect to the total cohort were kappa>or=0.86 and rho>or=0.74 respectively. The association between PVL and gross motor outcome at T4 was strong (positive and negative predictive values 0.92 and 0.85 respectively). The proportion of children who remained in the same GMFCS level increased from 27% (T1-T4) to 53% (T2-T4) and 72% (T3-T4). PVL grade I to II, as diagnosed in the neonatal period, has a better functional mobility prognosis than PVL grade III-IV. These findings have implications for habilitation counselling and intervention strategies.
