Prognostic factors for cerebral palsy and motor impairment in children born very preterm or very low birthweight: a systematic review

Abstract

Aim There is a large literature reporting risk factor analyses for poor neurodevelopment in children born very preterm (VPT: ≤32wks) or very low birthweight (VLBW: ≤1250g), which to date has not been formally summarized. The aim of this paper was to identify prognostic factors for cerebral palsy (CP) and motor impairment in children born VPT/VLBW. Method A systematic review was conducted using Medline, Embase, and Pyscinfo databases to identify studies published between 1 January 1990 and 1 June 2014 reporting multivariable prediction models for poor neurodevelopment in VPT/VLBW children (registration number CRD42014006943). Twenty‐eight studies for motor outcomes were identified. Results There was strong evidence that intraventricular haemorrhage and periventricular leukomalacia, and some evidence that the use of postnatal steroids and non‐use of antenatal steroids, were prognostic factors for CP. Male sex and gestational age were of limited use as prognostic factors for CP in cohorts restricted to ≤32 weeks gestation; however, in children older than 5 years with no major disability, there was evidence that male sex was a predictive factor for motor impairment. Interpretation This review has identified factors which may be of prognostic value for CP and motor impairment in VPT/VLBW children and will help to form the basis of future prognostic research.

Predictive value of the Movement Assessment Battery for Children ‐ Second Edition at 4 years, for motor impairment at 8 years in children born preterm

“…[7][8][9] These include highrisk medical issues such as brain abnormality/injury and postnatal corticosteroids, which have been linked with worse motor outcomes. [7][8][9] These include highrisk medical issues such as brain abnormality/injury and postnatal corticosteroids, which have been linked with worse motor outcomes.…”

“…[7][8][9] These include highrisk medical issues such as brain abnormality/injury and postnatal corticosteroids, which have been linked with worse motor outcomes. 7 Importantly, there is currently no consensus on which factors are associated with improvement or decline in motor proficiency during school age. 7 Importantly, there is currently no consensus on which factors are associated with improvement or decline in motor proficiency during school age.…”

Computer-based video analysis identifies infants with absence of fidgety movements

“…Prognostic models based on gestational age, neonatal morbidities and therapeutic interventions like the use of steroids in the neonatal period (4), as well as neurological assessment tools (5,6), magnetic resonance imaging (MRI) (7) or a combination of these (8,9), may be used to predict outcomes in high-risk infants. A common finding is that accuracy of neurologic assessment increases with age on assessment, delaying interventions beyond the time when brain plasticity is assumed to be at its highest (10,11).…”

Predicting motor impairments among children born extremely preterm or very low birthweight

“…1 The study is strengthened by its focus on a relatively homogenous outcome because parents and health policy professionals might regard the impact on quality of life differently for major motor impairment as compared to major cognitive or sensory impairments. The primary prognostic risk factors identified were major brain ultrasound abnormalities (large intraventricular/intracerebral hemorrhage and periventricular leukomalacia), male sex, antenatal glucocorticoid exposure (which predicts a lower risk), and postnatal steroids (which predicts a higher risk).…”

“…1 These goals direct us to a greater extent than individual diagnoses which are often unrelated to the complexity of our tasks. Nonetheless, in many countries funding streams still follow diagnostic categories.…”