Elsevier

Early Human Development

Volume 90, Issue 10, October 2014, Pages 571-578
Early Human Development

Follow-up at age 10 years in ELBW children — Functional outcome, brain morphology and results from motor assessments in infancy,☆☆

https://doi.org/10.1016/j.earlhumdev.2014.07.005Get rights and content

Highlights

  • ELBW children with early abnormal motor repertoire show composite deficits

  • GMA might contribute as early biomarker for later development

  • ELBW children have regionally reduced cortical-surface at age 10

  • Non-CP ELBW children have working memory deficits at age 10

  • ELBW children have reduced brain volumes at age 10

Abstract

Background

Extremely-low-birth-weight (ELBW) children without severe brain injury or CP are at high risk of developing deficits within cognition, attention, behavior and motor function. Assessing the quality of an infant's spontaneous motor-repertoire included in Prechtl's General-Movement-Assessment (GMA) has been shown to relate to later motor and cognitive functioning in preterm children without CP.

Aims

To investigate functional outcome and cerebral MRI morphometry at 10 years in ELBW children without CP compared to healthy controls and to examine any relationship with the quality of infant-motor-repertoire included in the GMA.

Study design

A cohort-study-design.

Subjects

31 ELBW children (mean birth-weight: 773 g, SD 146, mean gestational age 26.1 weeks, SD 1.8) and 33 term-born, age-matched controls.

Outcome measures

GMA was performed in ELBW children at 3 months corrected age. At 10 years the children underwent comprehensive motor, cognitive, behavioral assessments and cerebral MRI.

Results

The non-CP ELBW children had similar full-IQ but poorer working memory, poorer motor skills, and more attentional and behavioral problems compared to controls. On cerebral MRI reduced volumes of globus pallidus, cerebellar white matter and posterior corpus callosum were found. Cortical surface-area was reduced in temporal, parietal and anterior-medial-frontal areas. Poorer test-results and reduced brain volumes were mainly found in ELBW children with fidgety movements combined with abnormal motor-repertoire in infancy.

Conclusion

Non-CP ELBW children have poorer functional outcomes, reduced brain volumes and cortical surface-area compared with term-born controls at 10 years. ELBW children with abnormal infant motor-repertoire seem to be at increased risk of later functional deficits and brain pathology.

Introduction

The survival rates of children born with extremely-low-birth-weight (ELBW, BW < 1000 g) have been increasing during the last decades [1]. However, the number of ELBW children who develop disabilities like cerebral palsy (CP), cognitive impairments, and psychiatric and behavioral problems is still high compared with term-born peers [2]. Increased incidence of perinatal brain injury is the most common cause of the neurologic morbidity reported in preterm born children [3]. The brain injuries include focal periventricular white matter necrosis and diffuse white matter injury with widespread gliosis and axonal damage that may have secondary effects on development of the immature cerebral cortex, thalamus, cerebellum and basal ganglia [3], [4]. A qualitative general movement assessment (GMA) in infants based on the observation of spontaneous movements during the early post-term period is a sensitive and non-intrusive method to predict motor disorders like CP in later childhood [5]. A recent study suggested that the quality of general movements might be an early predictor also for cognitive function in very preterm born children [6] however, that study did not include motor or behavioral outcomes. We previously reported that the assessment of infant motor repertoire in a group of high risk neonates might be an early clinical marker for a composite of later motor dysfunction and cognitive impairments in non-CP children [7]. As an extension of that study we now aimed to examine the functional outcome and brain pathology evaluated with MRI morphometry at age 10 years in a cohort of ELBW children without CP compared with healthy term-born controls. In addition, we aimed to study whether early infant motor repertoire in the ELBW children that did not develop CP was associated with functional outcome and cerebral MRI findings at age 10. We hypothesized that non-CP ELBW children would have inferior functional test results and more brain pathology than controls and that pathological outcome would be related to abnormal early motor repertoire.

Section snippets

Methods

This geographically based follow-study included three year-cohorts of ELBW children born at the Trondheim University Hospital in Norway during the years 1999–2001. Inclusion criteria were children with birth-weight below 1000 g who participated in the regular follow-up at the Trondheim University Hospital. Exclusion criteria were diagnosed congenital syndromes. A total of 74 ELBW children were born and admitted to the Neonatal Intensive Care Unit (NICU) in Trondheim during the three year period.

Results

Clinical characteristics of the whole study population (including the CP children) are described in Table 1. At 10 years follow-up eight ELBW children (26%) were diagnosed with CP. Four of them had a spastic unilateral, three had diplegic and one child had quadriplegic CP. Four of the eight ELBW children with CP had intraventricular hemorrhage grade 4 or cystic periventricular leukomalacia diagnosed on neonatal cerebral ultrasonography. The children with CP were assessed clinically and with MRI,

Discussion

Compared with controls, the ELBW children without CP in this study had smaller brain volumes and regional reduction in cortical surface area, poorer working memory and motor skills and more parent-reported problems with attention, hyperactivity and executive function at 10 years. In addition, to our knowledge this is the first study to investigate the relationship between the quality of infant motor repertoire implemented in the general movement assessment and a morphometric MRI analysis at 10 

Conflict of interest

The authors have no conflicts of interest to disclose.

Acknowledgments

We thank the participating children and their parents for their co-operation and psychologist Lars M Rimol, PhD for producing the cortical surface area map (Fig. 1) based on the FreeSurfer software in the manuscript.

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  • Cited by (0)

    Funding Source: The study was funded by the Norwegian University of Science and Technology (NTNU), Trondheim and by the Liaison Committee between the Central Norway Regional Health Authority and NTNU (Grant number 46039500).

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    Financial Disclosure: The authors have no financial relationships to disclose.

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