Original article
The Quality of the Early Motor Repertoire in Preterm Infants Predicts Minor Neurologic Dysfunction at School Age

https://doi.org/10.1016/j.jpeds.2007.12.047Get rights and content

Objective

The quality of a child's motor repertoire at age 3 to 4 months postterm is predictive of later cerebral palsy (CP). Its predictive power for minor neurologic dysfunction (MND) is unclear. This study aimed to investigate the predictive value of the quality of the early motor repertoire for the development of MND at school age.

Study design

We assessed the motor repertoire from video recordings made at 6 to 24 weeks postterm in 82 preterm infants (mean gestational age, 29.7 ± 1.9 weeks; mean birth weight, 1183 ± 302 g). At age 7 to 11 years, Touwen's neurologic examination was performed, and the children were classified as normal (n = 49; 60%), MND (n = 18; 22%), or CP (n = 15; 18%).

Results

Multiple logistic regression analysis showed that the quality of fidgety movements (FMs) and the quality of the concurrent motor repertoire had independent prognostic value for MND at school age. Abnormal FMs evolved into MND in 64% of the children. Nine of the 28 children with normal FMs and an abnormal concurrent motor repertoire developed abnormally (32%). Only 1 child of the 21 children with normal FMs and a normal concurrent motor repertoire developed MND (5%).

Conclusions

Assessment of the quality of the early motor repertoire can accurately identify individual infants at high and low risk for MND at school age.

Section snippets

Subjects

The study group comprised 82 infants (50 boys and 32 girls) born preterm between September 1992 and October 1997 and admitted to the neonatal intensive care unit (NICU) of the Beatrix Children's Hospital of the University Medical Center of Groningen. The infants were members of a larger group of 99 infants who were included in prospective studies of the prognostic value of the quality of GMs for neurologic and developmental findings. The results of these studies have been reported previously.5,

Neurologic and Movement ABC Findings at School Age

At age 7 to 11 years, 15 children had developed CP (5 unilateral, 8 bilateral, 2 dyskinetic). Of the remaining 67 children, 36 were neurologically normal, 13 had simple MND, and 18 had complex MND. Most children with complex MND had abnormalities in the clusters coordination/ balance and fine manipulative ability. This combination of abnormal clusters was present in only 3 of the children with simple MND.

All clusters of the neurologic test except reflexes correlated significantly with the

Discussion

In children born preterm, the quality of the motor repertoire at 11 to 16 weeks postterm is related to clinically relevant MND (complex MND) at age 7 to 11 years. Both characteristics predictive for an abnormal outcome and characteristics predictive for a normal outcome were identified. Indicative for an abnormal outcome was the presence of abnormal FMs, which was followed by complex MND in nearly 67% of the cases. Features that were predictive of normal findings at school age were normal FMs

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