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Movement Difficulties at Age Five Among Extremely Preterm Infants
Adrien M Aubert1, Raquel Costa2, Ulrika Ådén3
1Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France.
Insights
Children born extremely preterm (EPT) have high rates of movement difficulties, affecting over half of those without cerebral palsy. Risk factors include lower gestational age, brain lesions, and maternal characteristics, highlighting the need for targeted early interventions.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Public Health
Background:
- Children born extremely preterm (EPT), before 28 weeks' gestational age, exhibit increased risks for motor impairments compared to term-born infants.
- Existing research shows inconsistent prevalence estimates and prognostic factors for movement difficulties in EPT populations, complicating early intervention strategies.
Purpose of the Study:
- To determine the prevalence of movement difficulties in children born EPT without cerebral palsy.
- To identify perinatal, neonatal, and sociodemographic risk factors associated with these movement difficulties.
Main Methods:
- A population-based cohort of 772 children born EPT in 11 European countries were assessed at 5 years using the Movement Assessment Battery for Children-Second Edition.
- Multinomial logistic regression analyzed associations between movement difficulties and collected sociodemographic, perinatal, and neonatal data.
Main Results:
- Over half of EPT children (23.2% at risk, 31.7% significant difficulties) exhibited movement difficulties.
- Significant difficulties were linked to lower gestational age, brain lesions, and postnatal corticosteroids. Male sex and bronchopulmonary dysplasia were associated with increased risk.
- Maternal factors (younger, primiparous, less educated, non-European born) also correlated with higher prevalence of significant movement difficulties.
Conclusions:
- A high prevalence of movement difficulties persists in EPT children even without cerebral palsy.
- Identified risk factors, including perinatal, neonatal, and sociodemographic variables, underscore the need for tailored early interventions and highlight country-specific variations.
Background And Objectives:
Children born extremely preterm (EPT), <28 weeks' gestational age, face higher risks of movement difficulties than their term-born peers. Studies report varying prevalence estimates and prognostic factors identifying children who could benefit from early intervention are inconsistent. This study investigated the prevalence of movement difficulties in children born EPT and associated risk factors.
Methods:
Data come from a population-based EPT birth cohort in 2011 and 2012 in 11 European countries. Children without cerebral palsy were assessed at 5 years of age (N = 772) with the Movement Assessment Battery for Children-Second Edition, which classifies movement difficulties as none (>15th percentile), at risk (6th-15th percentile) and significant (≤5th percentile). Associations with sociodemographic, perinatal, and neonatal characteristics collected from obstetric and neonatal medical records and parental questionnaires were estimated using multinomial logistic regression.
Results:
We found 23.2% (n = 179) of children were at risk for movement difficulties and 31.7% (n = 244) had significant movement difficulties. Lower gestational age, severe brain lesions, and receipt of postnatal corticosteroids were associated with significant movement difficulties, whereas male sex and bronchopulmonary dysplasia were associated with being at risk and having significant movement difficulties. Children with younger, primiparous, less educated, and non-European-born mothers were more likely to have significant movement difficulties. Differences in prevalence between countries remained after population case-mix adjustments.
Conclusions:
This study confirms a high prevalence of movement difficulties among EPT children without cerebral palsy, which are associated with perinatal and neonatal risk factors as well as sociodemographic characteristics and country.
