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Motor-related health care for 5-year-old children born extremely preterm with movement impairments
Raquel Costa1,2, Adrien M Aubert3, Anna-Veera Seppänen3
1EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
Insights
Many children born extremely preterm experience motor difficulties and cerebral palsy, yet most do not receive necessary motor-related health care (MRHC). Increased access to MRHC is crucial for these vulnerable children.
Area of Science:
- Pediatrics
- Developmental Pediatrics
- Neurology
Background:
- Extremely preterm (EPT) birth (<28 weeks gestation) is associated with increased risk of developmental challenges.
- Motor difficulties, including cerebral palsy (CP), are common sequelae in EPT survivors.
- Timely access to motor-related health care (MRHC) is essential for optimizing outcomes in children with motor impairments.
Purpose of the Study:
- To determine the prevalence of movement difficulties and CP in 5-year-old children born EPT.
- To assess the proportion of these children receiving MRHC.
- To identify factors associated with MRHC receipt among EPT children.
Main Methods:
- Longitudinal cohort study of 807 children born EPT across 11 European countries.
- Movement assessment using the Movement Assessment Battery for Children, Second Edition (MABC-2) at 5 years of age.
- Parent-reported data on child health, diagnoses (including CP), and healthcare utilization (MRHC defined as visits with specialized therapists).
Main Results:
- 21.1% were at risk of movement difficulties, 24.9% had significant movement difficulties (SMD), and 11.4% had CP.
- MRHC receipt was high for children with CP (89.1%) but lower for those with SMD (42.8%) and at risk (25.9%).
- Significant geographical variations in MRHC provision were observed across Europe; children with co-occurring developmental or socioemotional difficulties were more likely to receive MRHC.
Conclusions:
- A substantial proportion of EPT children experience motor difficulties without CP, and most do not receive adequate MRHC.
- Efforts are needed to improve access to and provision of MRHC for EPT children with motor impairments.
- Addressing geographical disparities and considering co-occurring conditions are important for equitable MRHC delivery.
Aim:
To (1) determine the proportion of 5-year-old children born extremely preterm (EPT) with movement difficulties including cerebral palsy (CP) and the proportion of these children receiving motor-related health care (MRHC), and (2) describe factors associated with receiving MRHC.
Method:
Children born before 28 weeks' gestation in 2011 to 2012 in 11 European countries were assessed with the Movement Assessment Battery for Children, Second Edition (MABC-2) at 5 years of age. Information on family characteristics, child health including CP diagnosis, and health care use were collected using parent-report questionnaires. MRHC was defined as visits in the previous year with health care providers (physical and occupational therapists) specialized in assessing/treating motor problems. We analysed receipt of MRHC and associated factors among children at risk of movement difficulties (MABC-2 score 6th-15th centiles), with significant movement difficulties (SMD; ≤5th centile) or with CP.
Results:
Of 807 children assessed at 5 years 7 months (SD 4 months; 4 years 7 months-7 years 1 month), 412 were males (51.1%), 170 (21.1%) were at risk of movement difficulties, 201 (24.9%) had SMD, and 92 (11.4%) had CP. Those who received MRHC comprised 89.1% of children with CP, 42.8% with SMD, and 25.9% at risk of movement difficulties. MRHC for children with SMD varied from 23.3% to 66.7% between countries. Children were more likely to receive MRHC if they had other developmental problems or socioemotional, conduct, or attention difficulties.
Interpretation:
Efforts are needed to increase MRHC for 5-year-old children born EPT with movement difficulties.
What This Paper Adds:
Children born extremely preterm without cerebral palsy frequently experienced motor difficulties. Most of these children were not receiving motor-related health care (MRHC). Large geographical differences throughout Europe were observed in receipt of MRHC. Socioemotional problems were related to MRHC use.
