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Neonatal white matter abnormality predicts childhood motor impairment in very preterm children
Alicia J Spittle1, Jeanie Cheong, Lex W Doyle
1Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, VIC, Australia. aspittle@unimelb.edu.au
Insights
White matter abnormalities (WMA) in very preterm infants predict motor impairments at age five. Higher WMA severity correlates with increased rates of moderate to severe motor impairment, necessitating childhood follow-up.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Neonatology
Background:
- Very preterm infants face risks for motor deficits, including cerebral palsy and developmental coordination disorder.
- White matter abnormalities (WMA) at term are linked to cerebral palsy in this population, but their impact on the spectrum of motor impairments is less understood.
Purpose of the Study:
- To investigate if WMA detected via MRI at term-equivalent age predict the full range of motor impairments in very preterm children at five years of age.
Main Methods:
- Brain MRI was used to assess WMA in 227 very preterm infants.
- Motor performance was evaluated at age five using the Movement Assessment Battery for Children (MABC).
- Logistic regression analyzed WMA as predictors of motor impairment, adjusting for perinatal factors and excluding cases of cerebral palsy.
Main Results:
- Over half of the assessed very preterm children (50%) exhibited mild to severe motor impairment, with 27% showing moderate to severe impairment.
- Mild WMA significantly increased the odds of moderate to severe motor impairment (OR 5.6) and mild to severe impairment (OR 2.2).
- Moderate to severe WMA markedly elevated the odds for moderate to severe impairment (OR 19.4) and mild to severe impairment (OR 9.4).
Conclusions:
- WMA at term are significant predictors of motor impairment in very preterm children at five years.
- The severity of WMA directly correlates with the likelihood and severity of motor impairment.
- All very preterm children diagnosed with WMA require ongoing developmental monitoring throughout childhood.
Aim:
Children born very preterm are at risk for impaired motor performance ranging from cerebral palsy (CP) to milder abnormalities, such as developmental coordination disorder. White matter abnormalities (WMA) at term have been associated with CP in very preterm children; however, little is known about the impact of WMA on the range of motor impairments. The aim of this study was to assess whether WMA were predictive of all levels of motor impairments in very preterm children.
Method:
Two hundred and twenty-seven very preterm infants (< 30 wks gestational age or birthweight < 1250 g) had brain magnetic resonance imaging at term-equivalent age to assess for WMA, which were categorized as nil, mild, or moderate to severe. At 5 years of age children were classified as having a moderate to severe motor impairment if they were below the 5th centile or mild to severe motor impairment if their score placed them no higher than the 15th centile on the Movement Assessment Battery for Children (MABC). WMA (nil vs mild and nil vs moderate-severe) were explored as predictors of motor impairment using logistic regression. Analyses were repeated adjusting for the effects of other perinatal variables and excluding children with CP.
Results:
Of the 193 very preterm children (97 males, 96 females) assessed with the MABC, 53 (27%) were classified as having a moderate to severe motor impairment and 96 (50%) a mild to severe motor impairment. WMA were predictive of motor impairment in very preterm children, with mild versus no WMA increasing the odds of moderate to severe motor impairment by over fivefold (odds ratio [OR] 5.6; 95% confidence interval [CI] 1.9-16.1; p=0.002) and mild to severe impairment by twofold (OR 2.2; 95% CI 1.1-4.2; p=0.02). Compared with no WMA, moderate to severe WMA increased the odds for moderate to severe impairment 19-fold (OR 19.4; 95% CI 5.6-66.7; p<0.001) and for mild to severe motor impairment ninefold (OR 9.4; 95% CI 3.2-28.1; p<0.001). Results remained similar after controlling for several potential confounders and after excluding 14 children who had CP at age 2 years.
Interpretation:
WMA predict motor impairment at 5 years, with rates of impairment increasing with more severe WMA. Very preterm children with any WMA at term require follow-up throughout childhood.
