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Predicting severe motor impairment in preterm children at age 5 years
Anne Synnes1, Peter J Anderson2, Ruth E Grunau1
1Department of Pediatrics, University of British Columbia, and Child and Family Research Institute, Vancouver, British Columbia, Canada.
Insights
Predicting severe motor impairment in children improves significantly between birth and 18 months. Early risk factors and assessments at 18 months enhance prediction accuracy for long-term motor outcomes.
Area of Science:
- Pediatric neurology
- Developmental pediatrics
- Clinical prediction modeling
Background:
- Early identification of severe motor impairment is crucial for timely intervention in high-risk infants.
- Predictive models for motor outcomes in very low birth weight (VLBW) infants evolve over the first few years of life.
Purpose of the Study:
- To evaluate the improvement in predicting severe motor impairment at age 5 years.
- To assess predictive accuracy changes from birth to 18 months corrected age.
Main Methods:
- An ancillary study of the Caffeine for Apnea of Prematurity Trial.
- Used a cumulative risk model with sequential predictor variables (neonatal, 36 weeks PMA, 18 months corrected age, sociodemographic).
- Compared receiver operating characteristic (ROC) curves to assess the increase in area under the curve (AUC).
Main Results:
- The area under the curve (AUC) for predicting severe motor impairment at 5 years increased from 0.650 at birth to 0.718 at 36 weeks postmenstrual age (PMA) and 0.797 at 18 months corrected age.
- The predictive accuracy significantly improved between birth and 18 months (p<0.001).
- Sociodemographic variables did not significantly enhance the predictive model's performance (AUC=0.806, p=0.07).
Conclusions:
- Predictive modeling for severe motor impairment at 5 years significantly improves from birth through 18 months corrected age in VLBW children.
- This highlights the importance of serial assessments for refining prognostic accuracy in high-risk neonates.
- The cumulative risk model effectively captures evolving risk factors influencing long-term motor development.
Objective:
To determine whether the ability to predict severe motor impairment at age 5 years improves between birth and 18 months.
Design:
Ancillary study of the Caffeine for Apnea of Prematurity Trial.
Setting And Patients:
International cohort of very low birth weight children who were assessed sequentially from birth to 5 years.
Outcome Measures:
Severe motor impairment was defined as a score <5th percentile on the Movement Assessment Battery of Children (MABC), or inability to complete the MABC because of cerebral palsy. Multivariable logistic regression cumulative risk models used four sets of predictor variables: early neonatal risk factors, risk factors at 36 weeks' postmenstrual age, risk factors at a corrected age of 18 months, and sociodemographic variables. A receiver operating characteristic curve (ROC) was generated for each model, and the four ROC curves were compared to determine if the addition of the new set of predictors significantly increased the area under the curve (AUC).
Results:
Of 1469 children, 291 (19.8%) had a severe motor impairment at 5 years. The AUC increased from 0.650 soon after birth, to 0.718 (p<0.001) at 36 weeks' postmenstrual age, and to 0.797 at 18 months (p<0.001). Sociodemographic variables did not significantly improve the AUC (AUC=0.806; p=0.07).
Conclusions:
Prediction of severe motor impairment at 5 years of age using a cumulative risk model improves significantly from birth to 18 months of age in children with birth weights between 500 g and 1250 g.
Trial Registration Number:
ClinicalTrials.gov number NCT00182312.
