Improving the outcome of infants born at <30 weeks' gestation - a randomized controlled trial of preventative care at home

Background: Early developmental interventions to prevent the high rate of neurodevelopmental problems in very preterm children, including cognitive, motor and behavioral impairments, are urgently needed. These interventions should be multi-faceted and include modules for caregivers given their high rates of mental health problems

General movements in very preterm children and neurodevelopment at 2 and 4 years

OBJECTIVE: Although similar to 50% of very preterm (VP) children have neurodevelopmental impairments, early prediction of infants who will experience problems later in life remains a challenge. This study evaluated the predictive value of general movements (GM; spontaneous and endogenous movements) at 1 and 3 months' corrected age for neurodevelopment at 2 and 4 years of age in VP children. METHODS: At 1 and 3 months' corrected age, infants born,30 weeks' gestation had GM assessed as normal or abnormal. Motor, cognitive, and language development at 2 years was assessed by using the Bayley Scales of Infant and Toddler Development, Third Edition. At 4 years, cognitive and language outcomes were assessed by using the Differential Ability Scale-Second Edition and motor outcomes with the Movement Assessment Battery for Children-Second Edition; a diagnosis of cerebral palsy was documented. RESULTS: Ninety-nine VP infants were recruited, with 97% and 88% of survivors followed up at age 2 and 4 years, respectively. Abnormal GM at 1 month were associated with worse motor outcomes at 2 and 4 years but not language or cognitive outcomes. Abnormal GM at 3 months were associated with worse motor, cognitive, and language outcomes at both 2 and 4 years. Overall, GM at 1 month demonstrated better sensitivity to impairments at 2 and 4 years, whereas GM at 3 months had better specificity and were more accurate overall at distinguishing between children with and without impairment. CONCLUSIONS: Abnormal GM in VP infants, particularly at 3 months postterm, are predictive of worse neurodevelopment at ages 2 and 4 years

Sensory profiles of children born < 30 weeks' gestation at 2 years of age and their environmental and biological predictors

Background: Sensory profiles are increasingly used by therapists to assess children. There is limited information on how sensory profiles differ between very preterm (VPT) children and term controls, or on the predictors of sensory profiles in VPT children

Does the Bayley-III motor scale at 2 years predict motor outcome at 4 years in very preterm children?

Aim To assess the predictive validity of the Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) for later motor outcome. Method Ninety-six infants (49 males, 47 females) born at less than 30weeks' gestation admitted to two tertiary hospitals in Melbourne, Australia, were assessed with the Bayley-III Motor Scale at 2years' corrected age and were classified as suspect or definite motor impairment if they scored less than 1 or 2 standard deviations respectively, relative to the test mean. At 4years' corrected age, children completed Movement Assessment Battery for Children Second Edition (MABC-2); for the total motor score, cut-offs of not more than the 15th were used to classify motor development and cut-offs of not more than the 15th centile were classified as having a significant movement difficulty. Results Of the 96 children assessed at both ages, at 2years 9% had suspect and 4% had definite motor impairment; however, by 4years, rates had increased to 22% and 19% respectively. The specificity of the Bayley-III for motor impairments for later motor outcome was excellent (ranging from 94 to 100% for cerebral palsy [CP] and 97 to 100% for motor impairment), although the sensitivity was low (ranging from 67 to 83% for CP and 18 to 37% for motor impairment); many children with later impairment were not identified by the Bayley-III. Interpretation The Bayley-III Motor Scale at 2years underestimates later rates of motor impairment, particularly in the absence of CP at 4years on the MABC-2 total motor score in children born at less than 30weeks' gestational age