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Clinical course of asymmetric motor performance and deformational plagiocephaly in very preterm infants
Jacqueline Nuysink1, Maria J C Eijsermans, Ingrid C van Haastert
1Child Development and Exercise Center, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. j.nuysink@umcutrecht.nl
Insights
Very preterm infants often develop positional preference and deformational plagiocephaly. While positional preference is common, chronic lung disease or slow motor development can predict persistent plagiocephaly, requiring intervention.
Area of Science:
- Neonatal development
- Pediatric neurology
- Developmental pediatrics
Background:
- Infants born very preterm (<30 weeks gestation or <1000 g) are at risk for positional preference and deformational plagiocephaly.
- Understanding the clinical course and predictive factors is crucial for timely intervention.
Purpose of the Study:
- To describe the clinical course of positional preference and deformational plagiocephaly up to 6 months corrected age (CA) in very preterm infants.
- To identify factors predicting the persistence of these conditions.
Main Methods:
- 120 very preterm infants were assessed three times.
- Deformational plagiocephaly and an asymmetry performance scale score were used as outcome measures at 6 months CA.
- Regression analysis identified predictive factors.
Main Results:
- Positional preference prevalence decreased from 65.8% at term-equivalent age (TEA) to 36.7% at 3 months CA.
- Deformational plagiocephaly prevalence increased from 30% at TEA to 50% at 3 months CA, then decreased to 23.3% at 6 months CA.
- Supine sleeping predicted asymmetric motor performance; chronic lung disease and/or slow gross motor maturation predicted persistent deformational plagiocephaly.
Conclusions:
- Deformational plagiocephaly is common in very preterm infants, with an optimistic course between 3 and 6 months CA.
- Positional preference at TEA is common and has limited predictive value for motor asymmetry.
- Early intervention is recommended for infants with chronic lung disease or delayed gross motor development.
Objectives:
To describe the clinical courses of positional preference and deformational plagiocephaly up to 6 months corrected age (CA) in infants born at gestational age <30 weeks or birth weight <1000 g, and to explore predictive factors for the persistence of these phenomena.
Study Design:
A total of 120 infants were examined 3 times each. The presence of deformational plagiocephaly and a score of 0-6 on an asymmetry performance scale served as outcome measures at 6 months CA. Predictive factors were determined using regression analysis.
Results:
The prevalence of a positional preference of the head was 65.8% (79 of 120) at term-equivalent age (TEA) and 36.7% (44 of 120) at 3 months CA and that of deformational plagiocephaly was 30% (36 of 120) at TEA and 50% (60 of 120) at 3 months CA. At 6 months CA, 15.8% of the infants (19 of 120) scored ≥ 2 of a possible 6 on the asymmetry performance scale and 23.3% (28 of 120) had deformational plagiocephaly. Sleeping in the supine position was predictive of an asymmetric motor performance at 6 months CA. Chronic lung disease and/or slow gross motor maturation at 3 months CA predicted the persistence of deformational plagiocephaly.
Conclusion:
Infants born very preterm may develop deformational plagiocephaly. A positional preference of the head at TEA seems to be a normal aspect of these infants' motor repertoire, with limited ability to predict persistence of an asymmetric motor performance. The decreased prevalence of deformational plagiocephaly between 3 and 6 months CA indicates an optimistic course. Infants with a history of chronic lung disease and/or slow gross motor maturation merit timely intervention.
