Motor‐related health care for 5‐year‐old children born extremely preterm with movement impairments

Abstract

Aim To (1) determine the proportion of 5‐year‐old children born extremely preterm (EPT) with movement difficulties including cerebral palsy (CP) and the proportion of these children receiving motor‐related health care (MRHC), and (2) describe factors associated with receiving MRHC. Method Children born before 28 weeks’ gestation in 2011 to 2012 in 11 European countries were assessed with the Movement Assessment Battery for Children, Second Edition (MABC‐2) at 5 years of age. Information on family characteristics, child health including CP diagnosis, and health care use were collected using parent‐report questionnaires. MRHC was defined as visits in the previous year with health care providers (physical and occupational therapists) specialized in assessing/treating motor problems. We analysed receipt of MRHC and associated factors among children at risk of movement difficulties (MABC‐2 score 6th–15th centiles), with significant movement difficulties (SMD; ≤5th centile) or with CP. Results Of 807 children assessed at 5 years 7 months (SD 4 months; 4 years 7 months–7 years 1 month), 412 were males (51.1%), 170 (21.1%) were at risk of movement difficulties, 201 (24.9%) had SMD, and 92 (11.4%) had CP. Those who received MRHC comprised 89.1% of children with CP, 42.8% with SMD, and 25.9% at risk of movement difficulties. MRHC for children with SMD varied from 23.3% to 66.7% between countries. Children were more likely to receive MRHC if they had other developmental problems or socioemotional, conduct, or attention difficulties. Interpretation Efforts are needed to increase MRHC for 5‐year‐old children born EPT with movement difficulties. What this paper adds Children born extremely preterm without cerebral palsy frequently experienced motor difficulties. Most of these children were not receiving motor‐related health care (MRHC). Large geographical differences throughout Europe were observed in receipt of MRHC. Socioemotional problems were related to MRHC use.

Low rates of motor‐related healthcare for 5‐year children born extremely preterm with movement difficulty: Where to next?

“…While research on motor outcomes for children born extremely preterm has previously focused on cerebral palsy (CP), a broader trend in the literature is now exploring non‐CP motor impairment, such as developmental coordination disorder (DCD). Consistent with this trend, Costa et al highlight the high rates of non‐CP motor impairment for children born extremely preterm 2 . Their study also draws attention to the proportion of children receiving motor‐related health care, such as physiotherapy, occupational therapy, or early intervention services, which was both concerningly low and highly variable between and within the 11 European countries included in the study 2 …”

“…As children born extremely preterm with non‐CP motor impairment are not consistently accessing motor‐related health care, 2 the next question should be ‘why?’. This paper discussed some hypotheses that provide possible future research directions worth pursuing, including the extent to which clinical practice guidelines are being met, as with a better understanding, services can be adapted to provide better outcomes for this cohort.…”

“…Finally, like many longitudinal cohort studies, children and families lost to follow‐up were more likely to be from lower socioeconomic groups, and hypothesized to be less likely to have received motor‐related health care 2 . It is worth noting that lower socioeconomic status is associated with greater risk of preterm birth in the first place 4 .…”

Can motor problems overlooked in infancy as ‘low‐normal’ affect function in later childhood?

“…3 Recent research suggests that in many aspects of neurointegrative functioning, a proportion of infants born preterm do not develop properly and often become increasingly disadvantaged. 4 Danks et al investigated the prevalence and prognostic value of 'low-normal' motor skills in high-risk infants. They found that high-risk infants with 'low-normal' motor skills might warrant referral to early intervention, as associated impairment represents an increased risk for poorer general development outcomes.…”

“…Recent research suggests that in many aspects of neurointegrative functioning, a proportion of infants born preterm do not develop properly and often become increasingly disadvantaged 4 . Danks et al investigated the prevalence and prognostic value of ‘low‐normal’ motor skills in high‐risk infants.…”