Preterm birth and developmental problems in the preschool age. Part I: minor motor problems

Abstract

Nearly half of very preterm (VP) and extremely preterm (EP) infants suffers from minor disabilities. The paper overviews the literature dealing with motor problems other than cerebral palsy (CP) during infancy and preschool age. The term "minor motor problems" indicates a wide spectrum of motor disorders other than CP; "minor" does not mean "minimal", as a relevant proportion of the preterm infants will develop academic and behavioural problems at school age. Early onset disorders consist of abnormal general movements (GMs), transient dystonia and postural instability; these conditions usually fade during the first months. They were underestimated in the past; recently, qualitative assessment of GMs using Prechtl's method has become a major item of the neurological examination. Late onset disorders include developmental coordination disorder (DCD) and/or minor neurological dysfunction (MND): both terms cover partly overlapping problems. Simple MND (MND-1) and complex MND (MND-2) can be identified and MND-2 gives a higher risk for learning and behavioural disorders. A relationship between the quality of GMs and MND in childhood has been recently described. The Touwen infant neurological examination (TINE) can reliably detect neurological signs of MND even in infancy. However, the prognostic value of these disorders requires further investigations.

The motor profile of preterm infants at 11 y of age

“…While the incidence of CP has slightly decreased due to vast advances in perinatal and neonatal care over the past decades (6), the rate of milder motor problems is reported to be significantly high in prematurely born children (7). Furthermore, these problems seem to continue when entering adulthood (8).…”

“…The Developmental Coordination Disorder (DCD) is defined as a motor impairment that appears in the absence of any obvious neurological and structural abnormality or intellectual disability that would interfere with activities of daily living or academic performance (9). The prevalence of DCD in school-aged children is 5-6%, the reported prevalence being higher in children born at very low birth weight or very preterm, from 9.5 to 51% (4,7,9,10).…”

Features of Physical and Neuro-Psychological Development of Children with Low, Very Low and Extremely Low Birth Weight in Different Age Periods of Life

“…Так, в ряде исследований был уста-новлен факт более медленного достижения таких мотор-ных навыков, как сидение, ползание, стояние и ходьба, среди недоношенных новорожденных, что, вероятнее всего, связано с дисбалансом мышц-сгибателей и мышц-разгибателей туловища [6][7][8][9]. В более длительном проспективном наблюдении моторной функции ЦНС у преж девременно рожденных, выполненном I. М. Husby и соавт., было показано, что молодые люди в возрас-те 14 и 23 лет, имевшие при рождении очень низкую массу тела, были более медлительными в движениях, имели меньшую ловкость, мелкая и крупная моторика была значительно беднее в сравнении с доношенными сверстниками (в работе не учитывались случаи детского церебрального паралича) [10].…”

Preterm and term‐equivalent age general movements and 1‐year neurodevelopmental outcomes for infants born before 30 weeks' gestation

“…16 It has also been used as the neurological outcome measure in previous studies examining the predictive validity of the GMA. 6 It assesses the neurological function of infants at post-term age across five clusters: reaching, gross motor, brainstem, visuomotor, and sensorimotor development.…”

“…15 It assesses neurodevelopment across gross motor, fine motor, neurological, postural, and sensory domains, with functional grades for each domain summed for a total functional grade score categorized as normal (score 6-8), minimal deviation (score 9-11), mild deviation (12-13), moderate deviation (14)(15)(16)(17)(18)(19), severe (20)(21)(22)(23)(24)(25), and profound (>25).…”