Decreased postural control in adolescents born with extremely low birth weight

Abstract

The survival rates of infants born preterm with extremely low birth weight (ELBW ≤ 1000 g) have gradually improved over the last decades. However, these infants risk to sustain long-term disorders related to poor neurodevelopment. The objective was to determine whether adolescents born with ELBW have decreased postural control and stability adaptation. Twenty-nine ELBW subjects performed posturography with eyes open and closed under unperturbed and perturbed standing by repeated calf vibration. Their results were compared with twenty-one age-and gender-matched controls born after full-term pregnancy. The ELBW group had significantly decreased stability compared with controls in anteroposterior direction, both during the easier quiet stance posturography (p = 0.007) and during balance perturbations (p = 0.007). The ELBW group had similar stability decrease in lateral direction during balance perturbations (p = 0.013). Statistically, the stability decreases were similar with eyes closed and open, but proportionally larger with eyes open in both directions. Both groups manifested significant adaptation (p ≤ 0.023) to the balance perturbations in anteroposterior direction, though this adaptation process could not compensate for the general stability deficits caused by ELBW on postural control. Hence, adolescent survivors of ELBW commonly suffer long-term deficits in postural control, manifested as use of substantially more recorded energy on performing stability regulating high-frequency movements and declined stability with closed and open eyes both in anteroposterior and lateral direction. The determined relationship between premature birth and long-term functional deficits advocates that interventions should be developed to provide preventive care in neonatal care units and later on in life.

The influence between gestational age and postural control, a systematic review

“…All the studies included underage participants, who were classified according to gestational age, regardless of birth weight and sex. Out of the 16 studies, eight provided the average gestational age per group ( 19 – 21 , 23 , 28 , 29 , 31 , 32 ); seven provided the intervals of gestational age which corresponded to each group ( 18 , 22 , 24 – 27 , 30 ), and one provided the data about the average gestational age of the preterm group, even though it did not provide data referring to the control group ( 33 ). The birth weight and sex of both groups was specified in 10 studies.…”

“…All the studies specified the intervention age, except for one ( 33 ), which only made reference to the age of the preterm group. Considering the last condition, it may be observed that seven studies were carried out during the first year of life of the participants ( 18 – 22 , 29 , 32 , 33 ), six were carried out from 3 to 10 years old ( 23 , 24 , 26 , 30 , 31 ), two were developed at the age of 13–17 years old ( 25 , 27 , 28 ) and one was carried out during the first year of life of the preterm infants group, but here the age of the control group was not specified ( 33 ). Out of the 16 studies included, six followed the evolution of the participants during a determined period of time; four were of a prospective nature ( 18 , 20 – 22 ), and two of a retrospective nature ( 32 , 33 ); the rest were cross-sectional studies.…”

“…Regarding the evaluation tools, six studies used posturography; four used it exclusively ( 23 , 27 , 28 , 31 ); one used it together with the Movement Assessment Battery for Children-second edition (MABC-2) ( 25 ); the last one used it together with the Test of Infant Motor Performance (TIMP) and Bayley Scale of Infant and Toddler Development (Bayley) ( 32 ). The Alberta Infant Motor Scale (AIMS) was used by five studies; one used it exclusively ( 20 ); another used it together with the Test of Security Functions (TSFI) ( 29 ); a third study used it together with the Neonatal Medical Index (NMI) ( 33 ); and the two remaining studies used it together with the Segmental Assessment of Trunk Control (SATCo) ( 18 , 28 ).…”

“…Dziuba et al ( 24 ) and Silva et al ( 26 ) did not find significant differences, and Rodríguez et al ( 25 ) did not find significant results for stabilometry except for the closed-eyes condition and over a viscoelastic foam surface (which were worse for the preterm group), but they did find significant differences for MABC-2. The study by Bucci et al ( 23 ), which considered the surface and the average speed of the centre of pressure (CoP), obtained worse result for the preterm infants group; whereas Petersen et al ( 27 ) showed by means of posturography worse results in the active and reactive postural stability of the preterm group with open and closed eyes in an anteroposterior direction and with open eyes in a lateral direction. Eshagui et al ( 30 ) found that the average scores in the four static balance subscales of BOT-2 were significantly lower in the preterm infants group.…”

Physiotherapy intervention for 4-5 year old children born extremely preterm and/or extremely low birth weight

“…At eight to 10 years of age, it has also been found that the postural stability of ELBW children is inadequate compared to that of typically developing children of similar age . Finally, Peterson et al have provided further evidence of postural control deficits amongst ELBW teenagers (Petersen et al, 2015).…”