Motor, cognitive, and behavioural disorders in children born very preterm

Abstract

Children born preterm have been shown to exhibit poor motor function and behaviour that is associated with school failure in the presence of average intelligence. A geographically determined cohort of two‐hundred and eighty preterm children (151 males, 129 females) born before 32 weeks’gestation and attending mainstream schools were examined at 7 to 8 years of age together with 210 (112 males, 98 females) age‐ and sex‐matched control participants were tested for motor, cognitive, and behavioural problems. Tests applied were the Movement Assessment Battery for Children (MABC), Clinical Observations of Motor and Postural Skills (COMPS), Developmental Test of Visual‐Motor Integration (VMI), Wechsler Intelligence Scale for Children, and Connors’Teacher Rating Scale for attention‐deficit‐hyper‐activity disorder (ADHD). Control children scored significantly better than the preterm group on all motor, cognitive, and behavioural measures. The lowest birthweight and most preterm individuals tended to score the lowest. Motor impairment was diagnosed in 86 (30.7%) of the preterm group and 14 (6.7%) of the control children using the MABC; 97 (42.7%) and 18 (10.2%) using the COMPS; and 68 (24.3%) and 17 (8.1%) respectively using the VMI. Each test of motor function identified different children with disability, although 23 preterm children were identified as having motor disability by all three tests. Preterm children were more likely to have signs of inattention and impulsivity and have a diagnosis of ADHD. Minor motor disabilities persist in survivors of preterm birth despite improvements in care and are not confined to the smallest or most preterm infants. They may exist independently of cognitive and behavioural deficits, although they often co‐exist. The condition is heterogeneous and may require more than one test to identify all children with potential learning problems.

Does the Bayley‐III Motor Scale at 2 years predict motor outcome at 4 years in very preterm children?

“…2 Movement and motor coordination are critical components of development, aiding functions such as learning to sit and eating in infancy, to playing with friends at kindergarten, and handwriting at school. 3 Perinatal complications such as low birthweight, gestational age, brain injury, and postnatal corticosteroids have all been associated with poorer motor outcomes in very preterm infants. 4 However, these perinatal complications do not account for all of the variance in motor outcomes, and other methods for identifying those children most at risk are required.…”

Decreased postural control in adolescents born with extremely low birth weight

“…Infants born with ELBW have a 20-25 % incidence of these disabilities (Halsey et al 1996; Bennett and Scott 1997;Aylward 2005), whereas full-term-born infants have a 5 % incidence (Paneth 1995). Other common disorders that might be difficult to detect before school age are learning disorders, attention deficiency hyperactivity disorder (ADHD), behavioral problems, sensory and motor system underdevelopment and reduced muscle strength (Samsom et al 2002;Foulder-Hughes and Cooke 2003). It has been estimated that as many as 50-70 % of infants born ≤1500 g (VLBW) suffers one or several dysfunctions of a severity that tends to increase with smaller birth weight (O'Callaghan et al 1996; Goyen et al 1998; Taylor et al 2000).…”

Developmental Characteristics of Infants According to their Gestational Age and Birth Weight

“…Follow up studies have shown that infants born very preterm with very low birth weight (VLBW) are at high risk of cerebral palsy (CP) and other developmental deficits [2][3][4][5] . Although not all premature infants and LBW infants develop disabilities or deficits, they may have problems, such as tension imbalance or inappropriate joint motion range and movement, or experience developmental delays due to immature regulation of alertness and improper automatic postural response 6) .…”