Neuroimaging and Bayley-III correlates of early hand function in extremely preterm children

Abstract

Objective(s)-Investigate associations between 18 and 22-month corrected age hand function, adverse findings on serial cranial ultrasound (CUS) and near-term brain MRI (ntMRI), and Bayley-III scores in extremely preterm (EPT) toddlers. Study design-Cohort analysis of Neonatal Research Network SUPPORT NEURO data. Associations between brain abnormalities, hand function, and Bayley-III scores were examined using chi-square and generalized linear mixed effect model analyses. Results-A total of 433 children were included. Sixteen percent had hand function deficits; these were associated with late CUS (p < 0.001) abnormalities, white matter abnormality (WMA) on ntMRI (p < 0.001), and Bayley-III scores. Six percent had CP. Fourteen percent of children without and 50% of those with CP had hand function abnormalities. Conclusions-Late CUS findings and severity of WMA were significantly associated with hand function deficits. Hand function deficits were nearly three times more common than CP and may be a useful marker of early brain insult and predictor of preterm birth effects on development.

Hand Function at 18-22 Months Is Associated with School-Age Manual Dexterity and Motor Performance in Children Born Extremely Preterm

“…Early Hand Function.-Pincer and grasp capacity, exaggerated hand preference, and ability to perform bimanual functions were assessed in detail at 18-22 months of corrected age using the 'hand function', 'upper limb function', and 'hand preference' subsections of the standardized NRN neuromotor examination (1). Clinicians trained and certified annually in this assessment perform this examination.…”

“…NRN examiners assessing hand function were masked to hospital morbidities. The Motor scale of the Bayley Scales of Infant-Toddler Development, 3 rd Edition was not part of the 18-22 month NRN assessment until after 2010, and was not available for the children included in this study (1).…”

“…We reran bivariate comparisons for the MABC subtests excluding the following groups, one at a time: (1) children with any level of CP, (2) children with moderate/severe CP, and (3) children with a full-scale intelligence quotient (IQ) < 70. After excluding these groups, hand function deficits at 18-22 months remained significantly associated with school-age Manual Dexterity scores only (Table 4; available at www.jpeds.com).…”

“…At school-age, fine motor deficits may affect daily functioning and school success (1). Successful participation in the majority of kindergarten activities requires fine motor proficiency (3).…”

Neuroimaging at Term Equivalent Age: Is There Value for the Preterm Infant? A Narrative Summary

“…While MRI has not yet emerged as a solitary tool, its role as contributing important data cannot be overlooked. It is for this reason that there is a consideration for TEA MRI to be integrated into a more extensive assessment, including physical examination findings, clinical risk factors (e.g., neonatal history of bronchopulmonary dysplasia and postnatal steroids) [ 151 , 152 ], standardized neurological and motor assessments (e.g., General Movement Assessment (GMA) [ 153 , 154 , 155 ], Hammersmith Infant Neurological Examination (HINE)) [ 155 , 156 , 157 , 158 ] for early identification of motor challenges, mainly CP [ 159 , 160 , 161 , 162 , 163 ]. In a retrospective case–control study of 441Italian high-risk infants, Morgan et al, 2019 found that the combined predictive power of the three-month HINE, GMA, and neuroimaging (MRI and/or cranial US) post-term gave sensitivity and specificity values of 97.86% and 99.22% (PPV 98.56%, NPV 98.84%) for detecting CP [ 164 ].…”