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Motor Impairment Trends in Extremely Preterm Children: 1991-2005
Alicia J Spittle1,2,3, Kate Cameron4,3, Lex W Doyle2,3,5,6
1Department of Physiotherapy, Melbourne School of Health Sciences, and aspittle@unimelb.edu.au.
Insights
Motor impairment rates increased in extremely preterm (EP) and/or extremely low birth weight (ELBW) children by age 8. This rise was driven by non-cerebral palsy motor impairments, not CP itself.
Area of Science:
- Pediatric neurology
- Developmental pediatrics
- Neonatal follow-up
Background:
- Increasing survival rates for extremely preterm (EP; <28 weeks gestation) and extremely low birth weight (ELBW; <1000g) children.
- Need to understand long-term neurodevelopmental outcomes, specifically motor impairment, in these vulnerable populations.
Purpose of the Study:
- To compare motor impairment rates at 8 years of age in EP and/or ELBW children across three distinct birth cohorts (1991-1992, 1997, 2005).
- To determine if motor impairment rates in these children are changing over time.
Main Methods:
- Longitudinal study of EP and/or ELBW children born in Victoria, Australia, recruited at birth.
- Matched term-born, normal birth weight controls were included for comparison.
- Motor impairment assessed at 8 years corrected age using standardized assessments, including the Movement Assessment Battery for Children (MABC) and MABC-2, and diagnosis of cerebral palsy (CP).
Main Results:
- Children born EP and/or ELBW consistently showed higher rates of motor impairment compared to term-born controls across all study periods.
- A significant increasing trend in motor impairment was observed in EP and/or ELBW children from 23% in 1991-1992 to 37% in 2005 (P = .001).
- This increase was primarily attributed to a rise in non-CP motor impairments, while CP rates remained stable.
Conclusions:
- Motor impairment rates at 8 years of age have significantly increased among children born EP and/or ELBW over the past two decades.
- The rise in motor impairment is predominantly due to an increase in non-cerebral palsy related motor deficits.
- These findings highlight evolving neurodevelopmental challenges in extremely preterm and/or low birth weight survivors.
Background:
There are increasing numbers of surviving children who were born extremely preterm (EP; gestational age <28 weeks) or extremely low birth weight (ELBW; birth weight <1000 g). Our objective in this study was to compare the rates of motor impairment at 8 years of age between 3 cohorts of EP and/or ELBW and term-born children to establish if motor impairment rates are changing over time.
Methods:
All children born EP and/or ELBW in the calendar years of 1991-1992, 1997, and 2005 in Victoria, Australia, were recruited at birth. Randomly selected normal birth weight (>2499 g) and term-born controls were matched for expected date of birth, sex, and sociodemographic status. At 8 years' corrected age, motor impairment was defined as cerebral palsy (CP) or a score less than the fifth centile on the Movement Assessment Battery for Children for the 1991-1992 and 1997 cohorts and less than or equal to the fifth centile on the Movement Assessment Battery for Children-Second Edition for the 2005 cohort.
Results:
Motor impairment was more likely in children born EP and/or ELBW compared with children born at term for all epochs. There was a significant increase in motor impairment in EP and/or ELBW children over the 3 eras, from 23% in 1991-1992 and 26% in 1997 to 37% in 2005 (χ2trend = 10.2; P = .001). This was due to an increase in non-CP motor impairment (13% in 1991 to 1992; 15% in 1997; 26% in 2005; χ2trend = 12.5; P < .001), not CP (11% in 1991 to 1992; 11% in 1997; 12% in 2005).
Conclusions:
The rate of motor impairment in EP and/or ELBW children assessed at 8 years of age increased between eras, an increase caused by non-CP motor impairment.
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