The development of head position preference in preterm infants beyond term age
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J J Geerdink1, B Hopkins, J B Hoeksma
1Department of Educational Sciences, Free University, Amsterdam, The Netherlands.
Insights
Preterm infants born before 32 weeks gestation may lack initial right-sided head preference. A midline head position, however, is not significantly delayed by prematurity or intrauterine growth retardation (IUGR), unless neurological issues are present.
Area of Science:
- Neonatal development
- Developmental pediatrics
- Neurology
Background:
- Healthy full-term infants typically develop a midline head position by 12 weeks.
- Head position preferences in preterm infants require further investigation.
Purpose of the Study:
- To investigate the effects of intrauterine growth retardation (IUGR) and prematurity on head position development in preterm infants.
- To assess the attainment of right-sided head preference and midline head position in preterm infants.
Main Methods:
- Studied 35 preterm infants (27-34 weeks gestation) from 35 weeks postmenstrual age to 18 weeks corrected age.
- Assessed head turning preferences (initial and sustained) and midline posture.
- Classified infants based on neurological differences, including movement quality.
Main Results:
- Infants born before 32 weeks gestation lacked initial right-sided head turning preference.
- Intrauterine growth retardation (IUGR) did not affect head position preferences.
- A midline head position was not significantly delayed by prematurity or IUGR.
- A delay in midline posture attainment was observed in infants with abnormal movement quality, potentially linked to suboptimal neurological condition or skull flattening.
Conclusions:
- Preterm infants born before 32 weeks gestation may exhibit altered head turning preferences.
- Midline head position development is generally resilient to prematurity and IUGR, but can be impacted by neurological factors.
- Abnormal movement quality in preterm infants may indicate delayed midline posture development, though skull shape can also be a factor.
Abstract:
Healthy full-term infants show a developmental trend in head position from an initial right-sided preference to one with the head in midline around the age of 12 weeks. We studied the effects of intrauterine growth retardation (IUGR) and the degree of prematurity on both aspects of development from 35 weeks postmenstrual age to 18 weeks corrected age in 35 preterm infants without overt neurological abnormalities and whose gestational ages ranged from 27 to 34 weeks. Our data reveal that, during the preterm period, infants born after pregnancies of 32 weeks or less showed a lack of right-sided preferences for head turning after release from midline but not for the subsequent maintenance of a position. IUGR did not seem to affect either preference. After term age a right-sided preference diminished while a head midline position increased. The latter was not significantly delayed in relation to birth before 32 weeks gestation or IUGR. However, when infants were classified on the basis of neurological differences as reflected in a (mildly) abnormal movement quality, a delay in the attainment of a midline posture was observed, which suggests it is related to a suboptimal neurological condition. This delay, however, was also accounted for by the side-to-side flattening of the skull.