Quality of Reaching and Postural Control in Young Preterm Infants Is Related to Neuromotor Outcome at 6 Years

Abstract

A substantial proportion of the "apparently normal" preterm infants exhibit minor and moderate dysfunctions in neuromotor outcome as they grow older. Birth characteristics, minor abnormalities on the neonatal ultrasound scan of the brain, and motor milestones have only limited value in the early detection of these children. The aim of the present study was to investigate whether nonoptimal reaching and relatively immobile postural behavior at an early age are associated with dysfunctional neuromotor and behavioural development at school age. The preterm children and full-term children of the present follow-up study participated in a previous study on the characteristics of reaching kinematics and the kinetics of posture at 4 and 6 mo corrected age. At the age of 6 y, the children were re-assessed by means of the Touwen neurologic assessment, the Movement ABC, and the Child Behavior Check List. The results demonstrated that in preterm children without cerebral palsy, a lack of successful reaching at 4 mo and a nonoptimal quality of reaching at 6 mo are related to the development of a complex form of minor neurologic dysfunction (MND) and fine manipulative disability at 6 y. Thus, these early signs indicate the presence of clinically significant brain dysfunction. A relatively immobile postural behavior at 4 mo was associated with simple MND, coordination problems, and at 6 mo with a worse score on the Movement ABC and internalizing behavior. This suggests that a relatively immobile postural behavior points to a mild form of brain dysfunction. A substantial proportion of "apparently neurologically normal" preterm infants do exhibit minor and moderate dysfunctions in neuromotor outcome as they grow older (1). Yet, these dysfunctions, which may seriously interfere with daily living activities, are not generally detected before school age. We therefore need to increase our knowledge of risk factors and patterns of early neuromotor development that relate to impaired motor outcome at school age. So far, the prospective value of birth characteristics and minor abnormalities on the neonatal ultrasound scan of the brain have been inconsistent for later motor impairments in this preterm group (1,2).Prediction of motor impairments at school age on the basis of the assessment of motor milestones at an early age is hampered by the presence of many false negatives (3,4). Prediction based on the quality of early motor behavior may be better. Recent work by 6) indicated that an abnormal quality of GM, which had been present until about 4 mo corrected age, was related to MND at early and later school age. A nonoptimal quality of specific motor functions, such as reaching and grasping at 9 mo, has also been associated with reduced quality of hand motor performance at 2.6 y (7).Preterm infants often show an abnormal quality of postural behavior (8), which has been addressed in terms of transient

Developmental outcomes and quality of life in children born preterm at preschool- and school-age

“…Dos 38 artigos,35 foram publicados no idioma inglês e três em português [53][54][55] . Vinte e um estudos avaliaram as crianças nascidas pré-termo na fase pré-escolar [18][19][20][21][26][27][28][29][31][32][33]36,41,42,[44][45][46]48,51,55 , e 17 artigos, na fase escolar [23][24][25]30,34,35,[37][38][39][40]43 Os indicadores de desenvolvimento avaliados nos estudos foram classificados, na presente revisão, em globais e específicos. O indicador global refere-se à avaliação em conjunto de mais de uma área do desenvolvimento, resultando, por conseguinte, em uma abordagem mais abrangente do desenvolvimento infantil.…”

“…Observa-se na Tabela 1 que, no total dos 38 estudos, o indicador de desenvolvimento mais prevalente foi a cognição [18][19][20][21][22]27,30,[33][34][35][36][37][38][39]43,46,47,49,[51][52][53] , seguido do desenvolvimento motor 19,20,[22][23][24][25][26][27][28][31][32][33]35,37,39,40,42,45,54 e do desenvolvimento neurossensorial 20,23,24,27,28,31,32,46,47,51,52,…”

“…Destaca-se que o Wechsler Preschool and Primary Intelligence Scale, utilizado para avaliar a cognição, apareceu em mais de 30% dos estudos 20,21,27,30,34,35,37,39,49,51,52,55 , e o exame neurológico padrão, que se trata de uma avaliação clínica, foi utilizado em cerca de 20% dos estudos 23,24,31,32,35,46,47,51,55 .…”

Early Parent-Administered Physical Therapy for Preterm Infants: A Randomized Controlled Trial

“…2,3 Postural control is a prerequisite for the development of optimal movement strategies, and reduced postural control in infants born preterm is related to reduced balance at 6 years. 4,5 In addition, a metaanalysis showed that prematurity is associated with motor impairments persisting throughout childhood. 6 The brains of infants born preterm are particularly vulnerable to lesions because of rapid brain maturation in the last trimester.…”

Predictive factors for neuromotor abnormalities at the corrected age of 12 months in very low birth weight premature infants

“…In the follow-up of these infants during the first year of life, various authors have detected abnormal neurological signs, while it has proven difficult to predict whether these signs will be transient or definitive [1][2][3] . The severity of illness in premature newborns related to lower gestational age and lower birth weight can be associated with abnormalities in muscle tone 4 and reflexes, thereby raising interest among neonatologists in risk factors related to altered infant development.…”