Early factors associated with risk of developmental coordination disorder in very preterm children: A prospective area‐based cohort study in Italy

Abstract

Background Developmental coordination disorder (DCD) is a motor disorder of unknown aetiology that may have long‐term consequences on daily activities, and psychological and physical health. Studies investigating risk factors for DCD have so far provided inconsistent results. Objectives To assess, using a parent‐report screening tool, risk of DCD in school‐age very preterm children born in Italy, and investigate the associated early biomedical and sociodemographic factors. Methods A prospective area‐based cohort (804 children, response rate 73.4%) was assessed at 8–11 years of age in three Italian regions. Perinatal data were abstracted from medical records. DCD risk was measured using the Italian‐validated version of the Developmental Coordination Disorder Questionnaire (DCDQ‐IT). For this study, children with cognitive deficit (i.e. intelligence quotient <70), cerebral palsy, severe vision and hearing disabilities, and other impairments affecting movement were excluded. A total of 629 children were analysed. We used inverse probability weighting to account for loss to follow‐up, and multilevel, multivariable modified Poisson models to obtain adjusted risk ratio (aRR) and 95% confidence interval (CI). Missing values in the covariates were imputed. Results 195 children (weighted proportion 31.8%, 95% CI 28.2, 35.6) scored positive on the DCDQ‐IT, corresponding to the 15th centile of the reference Movement‐ABC test. Factors associated with overall DCD risk were male sex (aRR 1.35, 95% CI 1.05, 1.73), intrauterine growth restriction (aRR 1.45, 95% CI 1.14, 1.85), retinopathy of prematurity (aRR 1.62, 95% CI 1.07, 2.45), and older maternal age at delivery (aRR 1.39, 95% CI 1.09, 1.77). Complete maternal milk feeding at discharge from the neonatal unit and higher parental socio‐economic status were associated with decreased risk. Conclusions Both biomedical and sociodemographic factors increase DCD risk. These findings can contribute to elucidating the origins of this disorder, and assist in the identification of children at risk for early referral and intervention.

Developmental coordination disorder subtypes in children: An unsupervised clustering

“…This recruitment bias was related to the local organization of care with dedicated referral centres for developmental motor problems (our team), intellectual disability, and speech/language disorders. Despite these possible recruitment biases, the general characteristics of our patients were consistent with those of previous series 25 …”

“…Despite these possible recruitment biases, the general characteristics of our patients were consistent with those of previous series. 25 T A B L E 3 Contributing components, main variables contributing for each cluster, and motor and visuospatial subtest results in each cluster. The typical cognitive profile was characterized by a discrepancy between the Verbal Comprehension Index (strong point) and Processing Speed Index (weak point).…”

Risk factors for cerebral palsy and movement difficulties in 5-year-old children born extremely preterm

“…A recent study from Italy also found that SGA was a risk factor for non-CP MD. 57 As SGA is not a risk factor for severe brain lesions, 58 this may explain the absence of association with CP. Low Apgar score, which can reflect poor adaptation at birth was reported to increase the risk of CP in the systematic review from van Lieshout et al 44,59 In their systematic review, Linsell et al 11 concluded that there was some evidence in VPT/very low birth weight populations that the use of postnatal corticosteroids increased the risk of CP, while the use of antenatal corticosteroids reduced risks.…”

Prognosis after very preterm birth: Insights for the future

“…In this special issue, the risks associated with social factors and the environment in relation to the outcomes of very preterm survivors are highlighted. Joseph et al 2 demonstrated that social disadvantage is a strong and independent risk factor for lower IQ in extremely preterm adolescents, more so than gestational age at birth, while Zoia et al 8 found parental education and occupation were independently associated with motor functioning and risk for Developmental Coordination Disorder in children born very preterm alongside clinical indicators such as male sex, small for gestational age and retinopathy of prematurity. When considering factors associated with long‐term outcomes, exposure to perinatal interventions should also be considered.…”