Functional Performance of Preterm Children at Age 4

Abstract

Functional performance, a child's ability to perform the tasks of daily living and to fulfill expected social roles, is now recommended in follow-up of preterm children. This study examined neonatal, preschool health, and motor effects on functional performance at age 4. The sample of 155 infants, classified by perinatal morbidity and birth weight, was assessed during a home visit. Neonatal illness, socioeconomic status, preschool health, and motor predictors explained 44% of the variance in functional performance. Functional performance is a useful clinical measure to understand how well preterm children perform age-expected daily activities as well as the family burden of preterm sequelae.Technological advances have resulted in improved survival rates for pre-term infants; yet, this is moderated by a growing concern for a greater prevalence of neurodevelopmental morbidity on the daily lives of these children (Aylward, 2005;Hack & Fanaroff, 1999;Vohr & Msall, 1997). Functional assessment, primarily used with adults, has been recommended in preterm follow-up as a measure of the overall burden of preterm morbidity (Saigal et al., 1994;Vohr & Msall, 1997). However, functional assessment of neonatal intensive care unit (NICU) survivors has received little empirical study (Hack, Taylor, Klein, & Minich, 2000;Msall, Tremont, & Ottenbacher, 2001). The concept of functional performance refers to the child's ability to perform the tasks of daily living and to fulfill expected social roles (McCabe & Granger, 1990;Vohr & Msall, 1997). In children, these tasks include feeding, dressing, bathing, toileting, moving inside and outdoors, communicating, playing, remembering routines, and interacting with others (Vohr & Msall, 1997). Social roles include peer group activities, school attendance and achievement, and community participation. In preterm children, functional performance represents the junction of a child's abilities and limitations and, thus, can provide critical data about the pathways to their assets and challenges and variation in outcomes (Msall & Tremont, 2000;Msall et al., 2001). Common sequelae of prematurity, motor delays, and subnormal health may affect functional performance. For example, a child who is clumsy or uncoordinated in gross and/or fine motor movement may not be able to button, zip, toilet independently, or play outdoors in developmentally appropriate sports activities. Thus, we can anticipate an additive effect of health status and motor abilities on functional performance. PURPOSEIn this study, we examine functional performance as an outcome and explore its relationships with health and motor outcomes for preschool preterm children born with varying birth weights and perinatal morbidities. We test the effect of perinatal morbidity © 2007 Elsevier Inc. All rights reserved. Address correspondence and reprint requests to Mary C. Sullivan, PhD, RN, University of Rhode Island, White Hall, Kingston, RI 02892. mcsullivan@uri.edu. (birth weight and neonatal illness) and preschool (age 4) healt...

Functional development of preterm infants: an integrative literature review

“…Preterm children have lower scores than the normative population in assessment tests of functional performance and are independent to carry out everyday activities in three main areas of functional development: self-care, mobility and social function (19,26,27,28).…”

“…In the study by Lemos et al (27), the sample delay percentage considering the area of functional abilities and independence of PEDI was 25.5% and 32.7%, respectively. Sullivan and Msall (19) found that preterm children scored lower on functional performance in the areas of self-care, sphincter control, transfers, mobility-locomotion, communication and social cognition. Snider et al (28) found a wide proportion of delay in functional performance in several areas: mobility, feeding, personal-social, communication, cognitive.…”

“…The authors discuss the possibility of negligence in the interactive activities and playing with the children, as mothers are more involved and concerned with other aspects such as their health conditions. Sullivan and Msall (19) note that current health status of preterm children in luence the caring behavior of families, warning that the cumulative effect of environmental and biological factors that in luence the functional development may also have important implications on how parents care their children and respond to vulnerabilities. It highlighted that preterm parents perceive the readiness for learning functional tasks of their children differently from full term parents.…”

“…Performance or functional performance is conceptualized as the ability to perform activities of daily living and meet the expectations of their social role (19). Examples of functional activities include: bathing, moving around indoors and outdoors, playing, dressing, eating, personal hygiene, communication, memory of routine activities, and interaction with other people, among others.…”

“…Examples of functional activities include: bathing, moving around indoors and outdoors, playing, dressing, eating, personal hygiene, communication, memory of routine activities, and interaction with other people, among others. As for the social role, they include participation in school, in the community and with other children (19).…”