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