Introduction
Severe early‐onset fetal growth restriction is an obstetric condition with significant risks of perinatal mortality, major and minor neonatal morbidity, and long‐term health sequelae. ...The prognosis of a fetus is influenced by the extent of prematurity and fetal weight. Clinical care is individually adjusted. In literature, survival rates vary and studies often only include live‐born neonates with missing rates of antenatal death. This systematic review aims to summarize the literature on mortality and morbidity.
Material and methods
A broad literature search was conducted in OVID MEDLINE from 2000 to 26 April 2019 to identify studies on fetal growth restriction and perinatal death. Studies were excluded when all included children were born before 2000 because (neonatal) health care has considerably improved since this period. Studies were included that described fetal growth restriction diagnosed before 32 weeks of gestation and antenatal mortality and neonatal mortality and/or morbidity as outcome. Quality of evidence was rated with the GRADE instrument.
Results
Of the 2604 publications identified, 25 studies, reporting 2895 pregnancies, were included in the systematic review. Overall risk of bias in most studies was judged as low. The quality of evidence was generally rated as very low to moderate, except for 3 large well‐designed randomized controlled trials. When combining all data on mortality, in 355 of 2895 pregnancies (12%) the fetus died antenatally, 192 died in the neonatal period (8% of live‐born neonates) and 2347 (81% of all pregnancies) children survived. Of the neonatal morbidities recorded, respiratory distress syndrome (34% of the live‐born neonates), retinopathy of prematurity (13%) and sepsis (30%) were most common. Of 476 children that underwent neurodevelopmental assessment, 58 (12% of surviving children, 9% of all pregnancies) suffered from cognitive impairment and/or cerebral palsy.
Conclusions
When combining the data of 25 included studies, survival in fetal growth restriction pregnancies, diagnosed before 32 weeks of gestation, was 81%. Neurodevelopmental impairment was assessed in a minority of surviving children. Individual prognostic counseling on the basis of these results is hampered by differences in patient and pregnancy characteristics within the included patient groups.
Aim
To investigate the magnitude of executive function deficits and their dependency on gestational age, sex, age at assessment, and year of birth for children born preterm and/or at low birthweight.
...Method
PubMed, PsychINFO, Web of Science, and ERIC were searched for studies reporting on executive functions in children born preterm/low birthweight and term controls born in 1990 and later, assessed at a mean age of 4 years or higher. Studies were included if five or more studies reported on the same executive function measures.
Results
Thirty‐five studies (3360 children born preterm/low birthweight, 2812 controls) were included. Children born preterm/low birthweight performed 0.5 standardized mean difference (SMD) lower on working memory and cognitive flexibility and 0.4 SMD lower on inhibition. SMDs for these executive functions did not significantly differ from each other. Meta‐regression showed that heterogeneity in SMDs for working memory and inhibition could not be explained by study differences in gestational age, sex, age at assessment, or year of birth.
Interpretation
Children born preterm/low birthweight since 1990 perform half a SMD below term‐born peers on executive function, which does not seem to improve with more recent advances in medical care or with increasing age.
What this paper adds
Children born preterm/low birthweight perform below term‐born children on core executive functions.
Lower gestational age or male sex are not risk factors for poorer executive functions.
Executive function difficulties in children born preterm/low birthweight remain stable across childhood.
Executive function difficulties are similar for children born recently and children born in earlier eras.
Resumen
Déficit en funciones ejecutivas en niños nacidos pretérmino o con bajo peso al nacer: un metaanálisis
Objetivo
Investigar la magnitud del déficit de funciones ejecutivas y su dependencia de la edad gestacional, sexo, edad a la evaluación y año de nacimiento de los niños nacidos pretérmino y/o bajo peso al nacer.
Metodo
Se buscaron en PubMed, PsychINFO, Web of Science y ERIC estudios que reportaran las funciones ejecutivas de los niños nacidos pretérmino y/o bajo peso al nacer y en niños nacidos de término como controles nacidos en 1990 y posterior, evaluados a una edad media de 4 años o más. Los estudios se incluyeron si 5 o más estudios informaban sobre las mismas medidas de la función ejecutiva.
Resultados
Se incluyeron 35 estudios (3360 niños nacidos pretérmino y/o bajo peso al nacer, 2812 controles). Estos niños tuvieron una diferencia media estandarizada (DME) de 0.5 en la memoria de trabajo y la flexibilidad cognitiva y 0.4 en la inhibición de la DME. La DMEs en funciones ejecutivas no tuvieron diferencias significativas entre ellos. La meta‐regresión mostró que la heterogeneidad de las DMEs para el trabajo de memoria y la inhibición no podría explicarse por la diferencia en la edad gestacional, sexo, edad a la evaluación o año de nacimiento.
Interpretacion
Los niños nacidos pretérmino y/o bajo peso al nacer desde 1990 realizan la mitad de un SMD por debajo de sus pares nacidos a término en la función ejecutiva, que no parece mejorar con los avances más recientes en la atención médica o con el aumento de la edad.
Resumo
Deficits da função executiva em crianças nascidas pré‐termo ou com baixo peso ao nascer: uma metanálise
Objetivo
Investigar a magnitude dos déficits da função executiva e sua dependência da idade gestacional, sexo, idade no momento da avaliação e ano de nascimento de crianças pré‐termo e / ou baixo peso ao nascer.
Método
PubMed, PsychINFO, Web of Science e ERIC foram pesquisados para estudos sobre funções executivas em crianças nascidas prematuras / com baixo peso ao nascer e controles a termo, nascidos em 1990 e anos posteriores, avaliados em uma idade média de 4 anos ou mais. Os estudos foram incluídos se 5 ou mais estudos relatassem as mesmas medidas de função executiva.
Resultados
Trinta e cinco estudos (3360 crianças nascidas pré‐termo / baixo peso ao nascer, 2812 controles) foram incluídos. As crianças nascidas pré‐termo / baixo peso ao nascer apresentaram uma diferença média padronizada (DMP) 0,5 menor na memória operacional e na flexibilidade cognitiva e DMP 0,4 menor na inibição. DMPs para essas funções executivas não diferiram significativamente entre si. Meta‐regressão mostrou que a heterogeneidade em DMPs para memória de trabalho e inibição não pode ser explicada pelas diferenças de estudo em idade gestacional, sexo, idade na avaliação ou ano de nascimento.
Interpretação
Crianças nascidas pré‐termo / baixo peso ao nascer desde 1990 realizam metade de um DMP abaixo de pares nascidos a termo em função executiva, o que não parece melhorar com os avanços mais recentes nos cuidados médicos ou com o aumento da idade.
What this paper adds
Children born preterm/low birthweight perform below term‐born children on core executive functions.
Lower gestational age or male sex are not risk factors for poorer executive functions.
Executive function difficulties in children born preterm/low birthweight remain stable across childhood.
Executive function difficulties are similar for children born recently and children born in earlier eras.
This article's has been translated into Spanish and Portuguese.
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Infants suffering from neonatal sepsis face an increased risk of early death and long‐term neurodevelopmental delay. This paper analyses and summarises the existing data on short‐term and long‐term ...outcomes of neonatal sepsis, based on 12 studies published between January 2000 and 1 April 2012 and covering 3669 neonates with sepsis.
Conclusion
Infants who have suffered neonatal sepsis face an increased risk of mortality and severe complications such as brain damage and, or, neurodevelopmental delay.
Objective Late-preterm infants (34 weeks 0/7 days-36 weeks 6/7 days' gestation) represent the largest proportion of singleton preterm births. A systematic review was performed to access the short- ...and/or long-term morbidity of late-preterm infants. Study Design An electronic search was conducted for cohort studies published from January 2000 through July 2010. Results We identified 22 studies studying 29,375,675 infants. Compared with infants born at term, infants born late preterm were more likely to suffer poorer short-term outcomes such as respiratory distress syndrome (relative risk RR, 17.3), intraventricular hemorrhage (RR, 4.9), and death <28 days (RR, 5.9). Beyond the neonatal period, late-preterm infants were more likely to die in the first year (RR, 3.7) and to suffer from cerebral palsy (RR, 3.1). Conclusion Although the absolute incidence of neonatal mortality and morbidity in infants born late preterm is low, its incidence is significantly increased as compared with infants born at term.
ABSTRACT
A previous randomized controlled trial has suggested the effectiveness of a Dutch postdischarge responsive parenting program for very preterm (VPT) infants, indicating that nationwide ...implementation was justified. This paper describes the development and nationwide implementation of the intervention, known as the TOP program, which consisted of three phases. In the preparation phase (2006–2010), a theory of change and the structure of the TOP program were developed, and funding for phase two, based on a positive Business Case, was obtained. In the pilot implementation phase (2010–2014), intervention strategies were developed for a real‐world setting, capacity and adoption were increased, systematic evaluations were incorporated, and sustained funding was obtained. In the full‐implementation phase (2014–2019), all Dutch Healthcare Insurers reimbursed the TOP program, enabling VPT infants to participate in the program without charge. By 2018, the number of interventionists that provided the TOP program had increased from 37 to 91, and all level III hospitals and 65% of regional hospitals in the Netherlands referred VPT infants. Currently, the program reaches 70% of the Dutch target population and parental satisfaction with the TOP program is high. After a 12‐year implementation period, the TOP program forms part of routine care in the Netherlands.
RESUMEN
Un previo ensayo controlado al azar ha sugerido la eficacia de un programa holandés sobre la crianza sensible para infantes muy prematuros (VPT) posterior al momento en que se les dio de alta, indicando que la implementación a lo largo de toda la nación era justificada. Este artículo describe el desarrollo y la implementación a nivel de toda la nación de la intervención, conocida como el programa ToP, el cual consistía de tres fases. En la fase de preparación (2006‐2010), se desarrollaron una teoría de cambio y la estructura del programa ToP, y se obtuvieron los fondos para la fase dos, con base en un Caso de Negocios (BC) positivo. En la fase piloto de implementación (2010‐2014), se desarrollaron estrategias de intervención para un escenario del mundo real, se aumentaron la capacidad y la adopción, se incorporaron evaluaciones sistemáticas y se obtuvieron fondos para mantener el programa. En la fase de implementación completa (2014‐2019), todas las Aseguradoras Holandesas del Sector Salud reembolsaron el costo del programa ToP, permitiéndoles a los infantes VPT participar en el programa sin costo alguno. Para 2018, el número de practicantes de la intervención que prestaban el servicio del programa ToP había aumentado de 37 a 91, y todos los hospitales del nivel III y 65% de los hospitales regionales en Holanda refirieron los infantes VPT al programa. Actualmente, el programa llega a 70% de la población holandesa para la cual está destinado y la satisfacción de los padres con el programa ToP es alta. Después de un período de implementación de 12 años, el programa ToP forma parte del cuidado de salud rutinario en Holanda.
RÉSUMÉ
Un essai contrôlé randomisé précédent a suggéré l'efficacité d'un programme hollandais de sensibilité de parentage après la sortie de l'hôpital pour les nourrissons grands prématurés (GP ici en français), indiquant qu'une mise en œuvre au niveau national était justifiée. Cet article décrit le développement et la mise en œuvre au niveau national de l'intervention, connue en tant que ToP program, qui a consisté en trois phases. Dans la phase de préparation (2006‐2010), une théorie du changement et la structure du programme ToP a été développée, et le financement pour la phase deux, basée sur une Etude de Cas positive, a été sécurisé. Dans la phase pilote d'implémentation (2010‐2014) des stratégies d'intervention ont été développées pour un contexte réel, la capacité et l'adoption ont été augmentées, les évaluations systématiques ont été incorporées, et un financement durable a été sécurisé. Dans la pleine phase de mise en œuvre (2014‐1029), tous les Assurances Santé Hollandaises ont remboursé le programme ToP, permettant aux nourrissons GP de participer au programme sans coût. En 2018 le nombre de prestataires qui offraient le programme ToP a augmenté de 37 à 91, et tous les hôpitaux de niveau III ainsi que 65% des hôpitaux régionaux aux Pays Bas ont envoyé les nourrissons GP au programme. En ce moment le programme atteint 70% de la population cible hollandaise et la satisfaction parentale avec le programme ToP est élevée. Après une période de mise en œuvre de 12 ans le programme ToP fait partie des soins de routine aux Pays Bas.
ZUSAMMENFASSUNG
Entwicklung und landesweite Umsetzung eines Interventionsprogramms für Eltern von sehr frühgeborenen Kindern nach der Entlassung: das ToP‐Programm
Eine frühere randomisierte kontrollierte Studie hat die Wirksamkeit eines niederländischen Interventionsprogramms für Eltern von sehr frühgeborenen (very preterm; VPT) Kindern nach der Entlassung nahegelegt. Dies wies darauf hin, dass eine landesweite Umsetzung gerechtfertigt wäre. Die vorliegende Studie beschreibt die aus drei Phasen bestehende Entwicklung und landesweite Umsetzung dieser, ToP‐Programm bekannten, Intervention. In der Vorbereitungsphase (2006–2010) wurden eine Veränderungstheorie und die Struktur des ToP‐Programms entwickelt und eine Finanzierung der zweiten Phase auf der Grundlage eines positiven Geschäftsszenarios (Business Case; BC) ermöglicht. In der Pilotimplementierungsphase (2010‐2014) wurden Interventionsstrategien für ein reales Umfeld entwickelt, Kapazität und Akzeptanz erhöht, systematische Evaluationen vorgenommen und eine nachhaltige Finanzierung realisiert. In der vollständigen Umsetzungsphase (2014‐2019) haben alle niederländischen Krankenversicherungen das ToP‐Programm erstattet, sodass VPT‐Säuglinge kostenlos am Programm teilnehmen konnten. Bis 2018 ist die Zahl der Anbietenden des ToP‐Programms von 37 auf 91 gestiegen und alle Krankenhäuser der Stufe III und 65% der regionalen Krankenhäuser in den Niederlanden überwiesen VPT‐Säuglinge. Derzeit erreicht das Programm 70% der niederländischen Zielgruppe und die Zufriedenheit der Eltern mit dem ToP‐Programm ist hoch. Nach einer 12‐jährigen Umsetzungsphase ist das ToP‐Programm Teil der Routineversorgung in den Niederlanden.
抄録
在胎32週未満の早産児向け退院後応答的育児介入プログラム“ToPプログラム”の沿革と全国的な実施
先行無作為化比較研究は、オランダの在胎32週未満の早産(VPT)乳児のための退院後応答的育児プログラムの有効性を示唆しており、全国的な実施の合理性が示された。本論文では、3つのフェーズからなるToPプログラムと呼ばれる介入の開発と全国的な実施について述べる。準備フェーズ(2006–2010)では、変化の理論とToPプログラムの構造が開発され、正のビジネスケース(BC)に基づいてフェーズ2の資金が調達された。パイロット導入フェーズ(2010–2014)では、実際の環境に適した介入戦略が策定され、機能と採用件数が増加し、体系的な評価が組み込まれ、持続的な資金源が得られた。完全実施フェーズ(2014–2019)では、オランダの全ての医療保険会社がToPプログラムに払い戻しを行い、VPTの乳児が無償でプログラムに参加できるようなった。2018年までに、ToPプログラムを提供する介入者の数は37人から91人に増加し、オランダの全てのレベルIIIの病院と地域病院の65%がVPT乳児を紹介した。現在、プログラムはオランダの対象人口の70%に普及し、ToPプログラムに対する親の満足度は高い。実施開始後12年が経過し、ToPプログラムはオランダでは日常的なケアの一部となっている。
摘要
此前的一项随机对照试验表明, 荷兰对极早产 (VPT) 婴儿的院后响应式育儿计划是有效的, 这表明在全国范围内实施是合理的。本文描述了干预措施的发展和在全国范围内的实施情况, 称为ToP计划, 分为三个阶段。在准备阶段 (2006–2010年) , 开发了变革理论和ToP计划的结构, 并基于积极的商业案例 (BC) 获得了第二阶段的资金支持。在试点实施阶段 (2010–2014年) , 针对现实环境制定了干预战略, 提高了业务能力和采用率, 纳入了系统评价, 并获得了持续的资金支持。在全面实施阶段 (2014–2019年) , 所有荷兰医疗保险公司都对ToP计划进行报销, 从而使VPT婴儿能够免费参与该计划。到2018年, 提供ToP计划的干预机构从37家增加到91家, 荷兰所有三级医院和65%的地区医院都将VPT婴儿纳入治疗范围。目前, 该计划覆盖了荷兰70%的目标人群, 并且父母对ToP项目的满意度很高。经过12年的实施期后, ToP计划已经成为荷兰常规护理的一部分。
ملخص
تطوير وتنفيذ برنامج رعاية والدية ا لمرحلة ما بعد خروج الأطفال المبتسرين من المستشفى: برنامج ToP
أشارت دراسة سابقة إلى فاعلية برنامج هولندي للرعاية الوالدية المستجيبة بعد خروج الرضع المبتسرين جداً (VPT) من المستشفى وأكدت على إمكانية تطبيقه على مستوى الدولة بشكل ناجح. تصف هذه الورقة تطوير وتنفيذ التدخل على مستوى الدولة، والمعروف باسم برنامج الـToP ، الذي يتكون من ثلاث مراحل. في مرحلة الإعداد (2006‐2010)، تم تطوير نظرية التغيير وهيكل برنامج الـToP ، وتم الحصول على تمويل للمرحلة الثانية، بناء على وضعه التجاري الإيجابي (BC) وفي مرحلة التنفيذ التجريبي (2010‐2014)، وضعت استراتيجيات للتدخل على أساس واقعي، وتم زيادة القدرات الاستيعابية والتبني ، واستخدام تقييمات منهجية، وبعد ذلك تم الحصول على تمويل مستدام. في مرحلة التنفيذ الكامل (2014‐2019)، قامت جميع شركات التأمين الصحي الهولندية بسداد تكاليف برنامجToP ، مما مكن الرضع من المشاركة في البرنامج دون مقابل. وبحلول عام 2018، ارتفع عدد المتدخلين الذين قدموا برنامج الـToP من 37 إلى 91، كما أن جميع مستشفيات المستوى الثالث و65% من المستشفيات الإقليمية في هولندا أصبحت تقوم بتحويل الرضع من برنامج ToP ، وفي الوقت الجالي يصل البرنامج إلى 70٪ من السكان المستهدفين الهولنديين ورضا الوالدين عن برنامجToP مرتفع. بعد فترة تنفيذ مدتها 12 عاماً، يشكل برنامج الـToP جزءاً من الرعاية الروتينية في هولندا.
Introduction
There is little evidence to guide the timing of delivery of women with early‐onset severe preeclampsia. We hypothesize that immediate delivery is not inferior for neonatal outcome but ...reduces maternal complications compared with temporizing management.
Material and methods
This Dutch multicenter open‐label randomized clinical trial investigated non‐inferiority for neonatal outcome of temporizing management as compared with immediate delivery (TOTEM NTR 2986) in women between 27+5 and 33+5 weeks of gestation admitted for early‐onset severe preeclampsia with or without HELLP syndrome. In participants allocated to receive immediate delivery, either induction of labor or cesarean section was initiated at least 48 hours after admission. Primary outcomes were adverse perinatal outcome, defined as a composite of severe respiratory distress syndrome, bronchopulmonary dysplasia, culture proven sepsis, intraventricular hemorrhage grade 3 or worse, periventricular leukomalacia grade 2 or worse, necrotizing enterocolitis stage 2 or worse, and perinatal death. Major maternal complications were secondary outcomes. It was estimated 1130 women needed to be enrolled. Analysis was by intention‐to‐treat.
Results
The trial was halted after 35 months because of slow recruitment. Between February 2011 and December 2013, a total of 56 women were randomized to immediate delivery (n = 26) or temporizing management (n = 30). Median gestational age at randomization was 30 weeks. Median prolongation of pregnancy was 2 days (interquartile range 1‐3 days) in the temporizing management group. Mean birthweight was 1435 g after immediate delivery vs 1294 g after temporizing management (P = .14). The adverse perinatal outcome rate was 55% in the immediate delivery group vs 52% in the temporizing management group (relative risk 1.06; 95% confidence interval 0.67‐1.70). In both groups there was one neonatal death and no maternal deaths. In the temporizing treatment group, one woman experienced pulmonary edema and one placental abruption. Analyses of only the singleton pregnancies did not result in other outcomes.
Conclusions
Early termination of the trial precluded any conclusions for the main outcomes. We observed that temporizing management resulted in a modest prolongation of pregnancy without changes in perinatal and maternal outcome. Conducting a randomized study for this important research question did not prove feasible.
Aim
This study determined possible discrepancies between verbal IQ and performance IQ in 8‐year‐old very preterm (VPT) and extremely preterm (EPT) children, and examined associations between verbal ...IQ and performance IQ, and sociodemographic factors, perinatal factors, early cognitive outcomes and also with school achievement scores.
Methods
This prospective cohort study included 120 eight‐year‐old VPT/EPT children. Cognitive development was assessed at the ages of 2, 5 and 8 years. Eight years’ school achievement results in arithmetic, reading and spelling were collected. Multiple regression analyses were performed to determine predictors of verbal IQ and performance IQ at the age of 8 years and to determine associations with school achievement scores.
Results
Mean performance IQ (89.8) was significantly lower than mean verbal IQ (99.4; Cohen's d = 0.59) at the age of 8 years. Gestational age (GA), small for GA status, and cognitive scores at the ages of 2 and 5 years significantly predicted verbal IQ and performance IQ at the age of 8 years. Performance IQ at age 8 years was an important predictor for arithmetic scores (β = 0.42).
Conclusion
Performance IQ was more strongly affected than verbal IQ in 8‐year‐old VPT/EPT children and was strongly related to mathematical difficulties.
Introduction
The ProTWIN trial previously showed no beneficial effect of treatment with a cervical pessary vs usual care to prevent preterm birth in women with a multiple pregnancy. However, in women ...with a midtrimester short cervix (<38 mm), pessary did reduce the composite outcome of neonatal morbidity and mortality. This follow‐up study evaluates the long‐term outcomes of all children born to mothers who participated in the ProTWIN trial at 4 years of age.
Material and methods
Parents received the Ages and Stages Questionnaire, Strength and Difficulties Questionnaire and a health questionnaire. All questionnaires were reported separately and as a combined outcome (abnormal child outcome). A linear mixed effects model was used to adjust for correlated data in twins and correction for confounders was performed. In exploratory analysis, a composite outcome of death or survival with abnormal child outcome was used by combining extrapolated data on child outcome with survival data. All data were analyzed for the total group and the subgroup of women with midtrimester short cervix.
Results
Of the original 813 women of the ProTWIN trial, we approached 579, of whom 258 participated (45%) in follow‐up. We received questionnaires of 514 children (281 pessary vs 233 control), with 119 children in the subgroup of women with midtrimester short cervix. An abnormal child outcome was found in 23% in the pessary group vs 16% in the control group (odds ratio 1.58; 95% confidence interval 0.94‐2.65). In exploratory analysis with extrapolated data on child outcome (n = 815), no difference in abnormal child outcome was seen between the pessary and control group. In the subgroup of women with a short cervix (n = 268), this composite outcome indicated a favorable outcome for children born to mothers with pessary.
Conclusions
In women with a multiple pregnancy, the use of a cervical pessary did not improve development, behavior or physical outcomes of the surviving children at age 4.
Post‐discharge preventive intervention programmes with involvement of the parent may support the resilience and developmental outcomes of infants born very preterm. Randomized controlled trials of ...home‐based family‐centred intervention programmes in very preterm infants that aimed to improve cognitive outcome, at least at age two, were selected and updated on the basis of a recent systematic review to compare their content and effect over time to form the basis of a narrative review. Six programmes were included in this narrative review. Four of the six programmes led to improved child cognitive and/or motor development. Two programmes, which focused primarily on responsive parenting and development, demonstrated improved cognitive outcome up till 5 years after completion of the programme. The programmes that also focused on maternal anxiety remediation led to improved maternal mental well‐being, along with improved child behaviour, in one study – even at 3 years after completion of the programme. The magnitude of the effects was modest. Family‐centred preventive intervention programmes that aim at improvement of child development should be continued after discharge home to improve the preterm child's resilience. Programmes may be most effective when they support the evolvement of a responsive parent–infant relationship over time, as well as the parent's well‐being.
What this paper adds
Responsive parenting is essential in post‐discharge interventions in preterm infants.
Responsive parenting can improve cognitive, motor, and behavioural outcomes in preterm infants.
Aim
To elucidate the relation between motor impairment and other developmental deficits in very preterm‐born children without disabling cerebral palsy and term‐born comparison children at 5 years of ...(corrected) age.
Method
In a prospective cohort study, 165 children (81 very preterm‐born and 84 term‐born) were assessed with the Movement Assessment Battery for Children ‐ 2nd edition, Touwen's neurological examination, the Wechsler Preschool and Primary Scale of Intelligence, processing speed and visuomotor coordination tasks of the Amsterdam Neuropsychological Tasks, and the Strengths and Difficulties Questionnaire.
Results
Motor impairment (≤15th centile) occurred in 32% of the very preterm‐born children compared with 11% of their term‐born peers (p=0.001). Of the very preterm‐born children with motor impairment, 58% had complex minor neurological dysfunctions, 54% had low IQ, 69% had slow processing speed, 58% had visuomotor coordination problems, and 27%, 50%, and 46% had conduct, emotional, and hyperactivity problems respectively. Neurological outcome (odds ratio OR=41.7, 95% confidence intervals CI 7.5–232.5) and Full‐scale IQ (OR=7.3, 95% CI 1.9–27.3) were significantly and independently associated with motor impairment. Processing speed (OR=4.6, 95% CI 1.8–11.6) and attention (OR=3.2, 95% CI 1.3–7.9) were additional variables associated with impaired manual dexterity. These four developmental deficits mediated the relation between preterm birth and motor impairment.
Interpretation
Complex minor neurological dysfunctions, low IQ, slow processing speed, and hyperactivity/inattention should be taken into account when very preterm‐born children are referred for motor impairment.
What this paper adds
Very preterm children with motor impairment have more developmental deficits than very preterm children without motor impairment
Behaviour problems are comparable between these groups
MND, IQ, processing speed, and hyperactivity/inattention mediate between preterm birth and motor impairment.
Motor impairment in term‐born children is not associated with developmental deficits.
This article is commented on by Zwicker on pages 514–515 of this issue.
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