Bos, Arend F.

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   University of GroningenEarly neuromotor performance and later cognition in children born pretermBos, Arend F.Published in:Developmental Medicine and Child NeurologyDOI:10.1111/dmcn.14901IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2021Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Bos, A. F. (2021). Early neuromotor performance and later cognition in children born preterm.Developmental Medicine and Child Neurology, 63(8), 891-891. Advance online publication.https://doi.org/10.1111/dmcn.14901CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 10-09-2023DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY COMMENTARYEarly neuromotor performance and later cognition in children bornpretermAREND F BOSUniversity Medical Center Groningen – Beatrix Children’s Hospital, Division ofNeonatology, University of Groningen, Groningen, the Netherlands.doi: 10.1111/dmcn.14901This commentary is on the original articles by Romeo et al. and Uusitaloet al. To view these papers visit https://doi.org/10.1111/dmcn.14768 andhttps://doi.org/10.1111/dmcn.14873.Prediction of neurodevelopmental outcomes after pretermbirth has interested neonatologists and health care workersinvolved in follow-up of children born preterm for decades.Whereas many studies demonstrate evidence regarding pre-diction of childhood outcomes in the motor domain, predic-tion of cognitive skills lags behind. Two new studies add tothis evidence by reporting moderately strong associationsbetween the scores on the Hammersmith Infant Neurologi-cal Examination (HINE) in infancy and cognition lateron.1,2 It is interesting that they report similar results, withthe associations remaining similarly strong after excludingchildren with cerebral palsy (CP) from their analyses. Thefindings in both studies are robust and include the completerange of preterm birth. They encompass the HINE per-formed at 3 to 12 months1 and at 24 months,2 with cognitivedevelopment measured at 2 years1 and 11 years2 respectively.The associations found have also been demonstrated inseveral studies regarding the predictive value of GeneralMovement Assessment (GMA) for later cognition.3 BothHINE and GMA have good predictive value for CP, butassociations with cognition are only moderately strong. Bothinstruments thus enable us to identify risk of cognitive delayat group level, but there is considerable overlap of scoresbetween children with typical and delayed cognitive devel-opment. This may preclude prediction on an individualbasis, as sensitivities between 3 to 12 months vary from 50%to 80%. It would be interesting to investigate whether thecombination of GMA and HINE in young infants wouldincrease the predictive value for later cognition, in line withwhat has been found for prediction of CP.The connection between early findings in the motordomain and later cognitive skills is very interesting. Intypically developing children born at term, motor develop-ment stimulates interaction with the environment, resultingin advancing development of various cognitive skills, by cre-ating new learning opportunities.4 Studies in children bornpreterm are scarce, but we can extrapolate from these find-ings. Although perinatal adverse events may disrupt neuronalstructures and connections in the developing brain, affectingboth motor and cognitive brain areas, an alternative hypoth-esis is that certain specific movements and postural patternsduring infancy are required for the infant to develop cogni-tive skills. If these patterns are atypical, abnormal, or absent,cognitive development will be impaired, because of disrup-tions of brain areas involved in motor skills, rather than cog-nition.4 This could also explain the lack of clear associationbetween magnetic resonance imaging findings and later cog-nition in children born preterm.The cause of the coocurring motor and cognitive delaycould be different between children born early pretermand moderate-to-late preterm. With advancing gestationalage, the disruptions of brain development are less severe,but the associations are still moderately strong.1 In linewith this, it has been reported that, in children born mod-erate-to-late preterm, earlier attainment of walking is asso-ciated with good problem-solving skills at 4 years.5 Buteven in children born very preterm, cognitive developmentmay be based on acquiring early motor skills. In the studyby Uusitalo et al., the HINE (at 2y) and cognitive scores(at 11y) were associated 9 years apart, whilst this associa-tion was not found for impaired motor outcomes such asdevelopmental coordination disorder.2The findings in both studies have important clinicalimplications. Lower scores on the HINE may identify chil-dren born preterm at risk for cognitive delay, enablinginterventions aimed at improving later cognition to startearlier than at present. It is tempting to conceive interven-tions that improve certain movements and postures becausethese were the items of the HINE that were associatedmost strongly with attainment of cognitive skills. Whetherthis indeed improves cognition in children born pretermshould be the subject of future longitudinal studies.REFERENCES1. Romeo DM, Cowan FM, Haataja L, et al. HammersmithInfant Neurological Examination for infants born preterm:predicting outcomes other than cerebral palsy. Dev MedChild Neurol 2021. https://doi.org/10.1111/dmcn.14768.2. Uusitalo K, Haataja L, Nyman A, Lehtonen T, Set€anenS, the PIPARI Study Group. The Hammersmith InfantNeurological Examination associates with long-termcognitive outcome in children born very preterm. DevMed Child Neurol 2021. https://doi.org/10.1111/dmcn.14873.3. Einspieler C, Bos AF, Libertus ME, Marschik PB. TheGeneral Movement Assessment helps us to identify pre-term infants at risk for cognitive dysfunction. FrontiersPsychol 2016; 7: 406.4. Oudgenoeg-Paz O, Mulder H Jongmans MJ, van derHam IJM, Van der Stigchel S. The link between motorand cognitive development in children born pretermand/or with low birth weight: a review of current evi-dence. Neurosci Biobehav Rev 2017; 80: 382–93.5. van Dokkum NH, Reijneveld SA, Bos AF, de KroonMLA. Attainment of smiling and walking in infancyassociates with developmental delays at school entry inmoderately-late preterm children: a community-basedcohort study. BMC Pediatr 2021; 21: 84.© 2021 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press. 1This is an open access article under the terms of the Creative Commons Attribution License, which permits use,distribution and reproduction in any medium, provided the original work is properly cited.

Early neuromotor performance and later cognition in children born preterm

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Dissertations of the University of Groningen

   University of GroningenEarly neuromotor performance and later cognition in children born pretermBos, Arend F.Published in:Developmental Medicine and Child NeurologyDOI:10.1111/dmcn.14901IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2021Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Bos, A. F. (2021). Early neuromotor performance and later cognition in children born preterm.Developmental Medicine and Child Neurology, 63(8), 891-891. https://doi.org/10.1111/dmcn.14901CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 05-06-2022DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY COMMENTARYEarly neuromotor performance and later cognition in children bornpretermAREND F BOSUniversity Medical Center Groningen – Beatrix Children’s Hospital, Division ofNeonatology, University of Groningen, Groningen, the Netherlands.doi: 10.1111/dmcn.14901This commentary is on the original articles by Romeo et al. and Uusitaloet al. To view these papers visit https://doi.org/10.1111/dmcn.14768 andhttps://doi.org/10.1111/dmcn.14873.Prediction of neurodevelopmental outcomes after pretermbirth has interested neonatologists and health care workersinvolved in follow-up of children born preterm for decades.Whereas many studies demonstrate evidence regarding pre-diction of childhood outcomes in the motor domain, predic-tion of cognitive skills lags behind. Two new studies add tothis evidence by reporting moderately strong associationsbetween the scores on the Hammersmith Infant Neurologi-cal Examination (HINE) in infancy and cognition lateron.1,2 It is interesting that they report similar results, withthe associations remaining similarly strong after excludingchildren with cerebral palsy (CP) from their analyses. Thefindings in both studies are robust and include the completerange of preterm birth. They encompass the HINE per-formed at 3 to 12 months1 and at 24 months,2 with cognitivedevelopment measured at 2 years1 and 11 years2 respectively.The associations found have also been demonstrated inseveral studies regarding the predictive value of GeneralMovement Assessment (GMA) for later cognition.3 BothHINE and GMA have good predictive value for CP, butassociations with cognition are only moderately strong. Bothinstruments thus enable us to identify risk of cognitive delayat group level, but there is considerable overlap of scoresbetween children with typical and delayed cognitive devel-opment. This may preclude prediction on an individualbasis, as sensitivities between 3 to 12 months vary from 50%to 80%. It would be interesting to investigate whether thecombination of GMA and HINE in young infants wouldincrease the predictive value for later cognition, in line withwhat has been found for prediction of CP.The connection between early findings in the motordomain and later cognitive skills is very interesting. Intypically developing children born at term, motor develop-ment stimulates interaction with the environment, resultingin advancing development of various cognitive skills, by cre-ating new learning opportunities.4 Studies in children bornpreterm are scarce, but we can extrapolate from these find-ings. Although perinatal adverse events may disrupt neuronalstructures and connections in the developing brain, affectingboth motor and cognitive brain areas, an alternative hypoth-esis is that certain specific movements and postural patternsduring infancy are required for the infant to develop cogni-tive skills. If these patterns are atypical, abnormal, or absent,cognitive development will be impaired, because of disrup-tions of brain areas involved in motor skills, rather than cog-nition.4 This could also explain the lack of clear associationbetween magnetic resonance imaging findings and later cog-nition in children born preterm.The cause of the coocurring motor and cognitive delaycould be different between children born early pretermand moderate-to-late preterm. With advancing gestationalage, the disruptions of brain development are less severe,but the associations are still moderately strong.1 In linewith this, it has been reported that, in children born mod-erate-to-late preterm, earlier attainment of walking is asso-ciated with good problem-solving skills at 4 years.5 Buteven in children born very preterm, cognitive developmentmay be based on acquiring early motor skills. In the studyby Uusitalo et al., the HINE (at 2y) and cognitive scores(at 11y) were associated 9 years apart, whilst this associa-tion was not found for impaired motor outcomes such asdevelopmental coordination disorder.2The findings in both studies have important clinicalimplications. Lower scores on the HINE may identify chil-dren born preterm at risk for cognitive delay, enablinginterventions aimed at improving later cognition to startearlier than at present. It is tempting to conceive interven-tions that improve certain movements and postures becausethese were the items of the HINE that were associatedmost strongly with attainment of cognitive skills. Whetherthis indeed improves cognition in children born pretermshould be the subject of future longitudinal studies.REFERENCES1. Romeo DM, Cowan FM, Haataja L, et al. HammersmithInfant Neurological Examination for infants born preterm:predicting outcomes other than cerebral palsy. Dev MedChild Neurol 2021. https://doi.org/10.1111/dmcn.14768.2. Uusitalo K, Haataja L, Nyman A, Lehtonen T, Set€anenS, the PIPARI Study Group. The Hammersmith InfantNeurological Examination associates with long-termcognitive outcome in children born very preterm. DevMed Child Neurol 2021. https://doi.org/10.1111/dmcn.14873.3. Einspieler C, Bos AF, Libertus ME, Marschik PB. TheGeneral Movement Assessment helps us to identify pre-term infants at risk for cognitive dysfunction. FrontiersPsychol 2016; 7: 406.4. Oudgenoeg-Paz O, Mulder H Jongmans MJ, van derHam IJM, Van der Stigchel S. The link between motorand cognitive development in children born pretermand/or with low birth weight: a review of current evi-dence. Neurosci Biobehav Rev 2017; 80: 382–93.5. van Dokkum NH, Reijneveld SA, Bos AF, de KroonMLA. Attainment of smiling and walking in infancyassociates with developmental delays at school entry inmoderately-late preterm children: a community-basedcohort study. BMC Pediatr 2021; 21: 84.© 2021 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press. 1This is an open access article under the terms of the Creative Commons Attribution License, which permits use,distribution and reproduction in any medium, provided the original work is properly cited.

ARTS repository - University of Groningen

   University of GroningenEarly neuromotor performance and later cognition in children born pretermBos, Arend F.Published in:Developmental Medicine and Child NeurologyDOI:10.1111/dmcn.14901IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2021Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Bos, A. F. (2021). Early neuromotor performance and later cognition in children born preterm.Developmental Medicine and Child Neurology, 63(8), 891-891. Advance online publication.https://doi.org/10.1111/dmcn.14901CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 31-10-2023DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY COMMENTARYEarly neuromotor performance and later cognition in children bornpretermAREND F BOSUniversity Medical Center Groningen – Beatrix Children’s Hospital, Division ofNeonatology, University of Groningen, Groningen, the Netherlands.doi: 10.1111/dmcn.14901This commentary is on the original articles by Romeo et al. and Uusitaloet al. To view these papers visit https://doi.org/10.1111/dmcn.14768 andhttps://doi.org/10.1111/dmcn.14873.Prediction of neurodevelopmental outcomes after pretermbirth has interested neonatologists and health care workersinvolved in follow-up of children born preterm for decades.Whereas many studies demonstrate evidence regarding pre-diction of childhood outcomes in the motor domain, predic-tion of cognitive skills lags behind. Two new studies add tothis evidence by reporting moderately strong associationsbetween the scores on the Hammersmith Infant Neurologi-cal Examination (HINE) in infancy and cognition lateron.1,2 It is interesting that they report similar results, withthe associations remaining similarly strong after excludingchildren with cerebral palsy (CP) from their analyses. Thefindings in both studies are robust and include the completerange of preterm birth. They encompass the HINE per-formed at 3 to 12 months1 and at 24 months,2 with cognitivedevelopment measured at 2 years1 and 11 years2 respectively.The associations found have also been demonstrated inseveral studies regarding the predictive value of GeneralMovement Assessment (GMA) for later cognition.3 BothHINE and GMA have good predictive value for CP, butassociations with cognition are only moderately strong. Bothinstruments thus enable us to identify risk of cognitive delayat group level, but there is considerable overlap of scoresbetween children with typical and delayed cognitive devel-opment. This may preclude prediction on an individualbasis, as sensitivities between 3 to 12 months vary from 50%to 80%. It would be interesting to investigate whether thecombination of GMA and HINE in young infants wouldincrease the predictive value for later cognition, in line withwhat has been found for prediction of CP.The connection between early findings in the motordomain and later cognitive skills is very interesting. Intypically developing children born at term, motor develop-ment stimulates interaction with the environment, resultingin advancing development of various cognitive skills, by cre-ating new learning opportunities.4 Studies in children bornpreterm are scarce, but we can extrapolate from these find-ings. Although perinatal adverse events may disrupt neuronalstructures and connections in the developing brain, affectingboth motor and cognitive brain areas, an alternative hypoth-esis is that certain specific movements and postural patternsduring infancy are required for the infant to develop cogni-tive skills. If these patterns are atypical, abnormal, or absent,cognitive development will be impaired, because of disrup-tions of brain areas involved in motor skills, rather than cog-nition.4 This could also explain the lack of clear associationbetween magnetic resonance imaging findings and later cog-nition in children born preterm.The cause of the coocurring motor and cognitive delaycould be different between children born early pretermand moderate-to-late preterm. With advancing gestationalage, the disruptions of brain development are less severe,but the associations are still moderately strong.1 In linewith this, it has been reported that, in children born mod-erate-to-late preterm, earlier attainment of walking is asso-ciated with good problem-solving skills at 4 years.5 Buteven in children born very preterm, cognitive developmentmay be based on acquiring early motor skills. In the studyby Uusitalo et al., the HINE (at 2y) and cognitive scores(at 11y) were associated 9 years apart, whilst this associa-tion was not found for impaired motor outcomes such asdevelopmental coordination disorder.2The findings in both studies have important clinicalimplications. Lower scores on the HINE may identify chil-dren born preterm at risk for cognitive delay, enablinginterventions aimed at improving later cognition to startearlier than at present. It is tempting to conceive interven-tions that improve certain movements and postures becausethese were the items of the HINE that were associatedmost strongly with attainment of cognitive skills. Whetherthis indeed improves cognition in children born pretermshould be the subject of future longitudinal studies.REFERENCES1. Romeo DM, Cowan FM, Haataja L, et al. HammersmithInfant Neurological Examination for infants born preterm:predicting outcomes other than cerebral palsy. Dev MedChild Neurol 2021. https://doi.org/10.1111/dmcn.14768.2. Uusitalo K, Haataja L, Nyman A, Lehtonen T, Set€anenS, the PIPARI Study Group. The Hammersmith InfantNeurological Examination associates with long-termcognitive outcome in children born very preterm. DevMed Child Neurol 2021. https://doi.org/10.1111/dmcn.14873.3. Einspieler C, Bos AF, Libertus ME, Marschik PB. TheGeneral Movement Assessment helps us to identify pre-term infants at risk for cognitive dysfunction. FrontiersPsychol 2016; 7: 406.4. Oudgenoeg-Paz O, Mulder H Jongmans MJ, van derHam IJM, Van der Stigchel S. The link between motorand cognitive development in children born pretermand/or with low birth weight: a review of current evi-dence. Neurosci Biobehav Rev 2017; 80: 382–93.5. van Dokkum NH, Reijneveld SA, Bos AF, de KroonMLA. Attainment of smiling and walking in infancyassociates with developmental delays at school entry inmoderately-late preterm children: a community-basedcohort study. BMC Pediatr 2021; 21: 84.© 2021 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press. 1This is an open access article under the terms of the Creative Commons Attribution License, which permits use,distribution and reproduction in any medium, provided the original work is properly cited.

University of Groningen

   University of GroningenEarly neuromotor performance and later cognition in children born pretermBos, Arend F.Published in:Developmental Medicine and Child NeurologyDOI:10.1111/dmcn.14901IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2021Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Bos, A. F. (2021). Early neuromotor performance and later cognition in children born preterm.Developmental Medicine and Child Neurology, 63(8), 891-891. https://doi.org/10.1111/dmcn.14901CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 20-11-2022DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY COMMENTARYEarly neuromotor performance and later cognition in children bornpretermAREND F BOSUniversity Medical Center Groningen – Beatrix Children’s Hospital, Division ofNeonatology, University of Groningen, Groningen, the Netherlands.doi: 10.1111/dmcn.14901This commentary is on the original articles by Romeo et al. and Uusitaloet al. To view these papers visit https://doi.org/10.1111/dmcn.14768 andhttps://doi.org/10.1111/dmcn.14873.Prediction of neurodevelopmental outcomes after pretermbirth has interested neonatologists and health care workersinvolved in follow-up of children born preterm for decades.Whereas many studies demonstrate evidence regarding pre-diction of childhood outcomes in the motor domain, predic-tion of cognitive skills lags behind. Two new studies add tothis evidence by reporting moderately strong associationsbetween the scores on the Hammersmith Infant Neurologi-cal Examination (HINE) in infancy and cognition lateron.1,2 It is interesting that they report similar results, withthe associations remaining similarly strong after excludingchildren with cerebral palsy (CP) from their analyses. Thefindings in both studies are robust and include the completerange of preterm birth. They encompass the HINE per-formed at 3 to 12 months1 and at 24 months,2 with cognitivedevelopment measured at 2 years1 and 11 years2 respectively.The associations found have also been demonstrated inseveral studies regarding the predictive value of GeneralMovement Assessment (GMA) for later cognition.3 BothHINE and GMA have good predictive value for CP, butassociations with cognition are only moderately strong. Bothinstruments thus enable us to identify risk of cognitive delayat group level, but there is considerable overlap of scoresbetween children with typical and delayed cognitive devel-opment. This may preclude prediction on an individualbasis, as sensitivities between 3 to 12 months vary from 50%to 80%. It would be interesting to investigate whether thecombination of GMA and HINE in young infants wouldincrease the predictive value for later cognition, in line withwhat has been found for prediction of CP.The connection between early findings in the motordomain and later cognitive skills is very interesting. Intypically developing children born at term, motor develop-ment stimulates interaction with the environment, resultingin advancing development of various cognitive skills, by cre-ating new learning opportunities.4 Studies in children bornpreterm are scarce, but we can extrapolate from these find-ings. Although perinatal adverse events may disrupt neuronalstructures and connections in the developing brain, affectingboth motor and cognitive brain areas, an alternative hypoth-esis is that certain specific movements and postural patternsduring infancy are required for the infant to develop cogni-tive skills. If these patterns are atypical, abnormal, or absent,cognitive development will be impaired, because of disrup-tions of brain areas involved in motor skills, rather than cog-nition.4 This could also explain the lack of clear associationbetween magnetic resonance imaging findings and later cog-nition in children born preterm.The cause of the coocurring motor and cognitive delaycould be different between children born early pretermand moderate-to-late preterm. With advancing gestationalage, the disruptions of brain development are less severe,but the associations are still moderately strong.1 In linewith this, it has been reported that, in children born mod-erate-to-late preterm, earlier attainment of walking is asso-ciated with good problem-solving skills at 4 years.5 Buteven in children born very preterm, cognitive developmentmay be based on acquiring early motor skills. In the studyby Uusitalo et al., the HINE (at 2y) and cognitive scores(at 11y) were associated 9 years apart, whilst this associa-tion was not found for impaired motor outcomes such asdevelopmental coordination disorder.2The findings in both studies have important clinicalimplications. Lower scores on the HINE may identify chil-dren born preterm at risk for cognitive delay, enablinginterventions aimed at improving later cognition to startearlier than at present. It is tempting to conceive interven-tions that improve certain movements and postures becausethese were the items of the HINE that were associatedmost strongly with attainment of cognitive skills. Whetherthis indeed improves cognition in children born pretermshould be the subject of future longitudinal studies.REFERENCES1. Romeo DM, Cowan FM, Haataja L, et al. HammersmithInfant Neurological Examination for infants born preterm:predicting outcomes other than cerebral palsy. Dev MedChild Neurol 2021. https://doi.org/10.1111/dmcn.14768.2. Uusitalo K, Haataja L, Nyman A, Lehtonen T, Set€anenS, the PIPARI Study Group. The Hammersmith InfantNeurological Examination associates with long-termcognitive outcome in children born very preterm. DevMed Child Neurol 2021. https://doi.org/10.1111/dmcn.14873.3. Einspieler C, Bos AF, Libertus ME, Marschik PB. TheGeneral Movement Assessment helps us to identify pre-term infants at risk for cognitive dysfunction. FrontiersPsychol 2016; 7: 406.4. Oudgenoeg-Paz O, Mulder H Jongmans MJ, van derHam IJM, Van der Stigchel S. The link between motorand cognitive development in children born pretermand/or with low birth weight: a review of current evi-dence. Neurosci Biobehav Rev 2017; 80: 382–93.5. van Dokkum NH, Reijneveld SA, Bos AF, de KroonMLA. Attainment of smiling and walking in infancyassociates with developmental delays at school entry inmoderately-late preterm children: a community-basedcohort study. BMC Pediatr 2021; 21: 84.© 2021 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press. 1This is an open access article under the terms of the Creative Commons Attribution License, which permits use,distribution and reproduction in any medium, provided the original work is properly cited.

   University of GroningenEarly neuromotor performance and later cognition in children born pretermBos, Arend F.Published in:Developmental Medicine and Child NeurologyDOI:10.1111/dmcn.14901IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2021Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Bos, A. F. (2021). Early neuromotor performance and later cognition in children born preterm.Developmental Medicine and Child Neurology, 63(8), 891-891. https://doi.org/10.1111/dmcn.14901CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 04-06-2022DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY COMMENTARYEarly neuromotor performance and later cognition in children bornpretermAREND F BOSUniversity Medical Center Groningen – Beatrix Children’s Hospital, Division ofNeonatology, University of Groningen, Groningen, the Netherlands.doi: 10.1111/dmcn.14901This commentary is on the original articles by Romeo et al. and Uusitaloet al. To view these papers visit https://doi.org/10.1111/dmcn.14768 andhttps://doi.org/10.1111/dmcn.14873.Prediction of neurodevelopmental outcomes after pretermbirth has interested neonatologists and health care workersinvolved in follow-up of children born preterm for decades.Whereas many studies demonstrate evidence regarding pre-diction of childhood outcomes in the motor domain, predic-tion of cognitive skills lags behind. Two new studies add tothis evidence by reporting moderately strong associationsbetween the scores on the Hammersmith Infant Neurologi-cal Examination (HINE) in infancy and cognition lateron.1,2 It is interesting that they report similar results, withthe associations remaining similarly strong after excludingchildren with cerebral palsy (CP) from their analyses. Thefindings in both studies are robust and include the completerange of preterm birth. They encompass the HINE per-formed at 3 to 12 months1 and at 24 months,2 with cognitivedevelopment measured at 2 years1 and 11 years2 respectively.The associations found have also been demonstrated inseveral studies regarding the predictive value of GeneralMovement Assessment (GMA) for later cognition.3 BothHINE and GMA have good predictive value for CP, butassociations with cognition are only moderately strong. Bothinstruments thus enable us to identify risk of cognitive delayat group level, but there is considerable overlap of scoresbetween children with typical and delayed cognitive devel-opment. This may preclude prediction on an individualbasis, as sensitivities between 3 to 12 months vary from 50%to 80%. It would be interesting to investigate whether thecombination of GMA and HINE in young infants wouldincrease the predictive value for later cognition, in line withwhat has been found for prediction of CP.The connection between early findings in the motordomain and later cognitive skills is very interesting. Intypically developing children born at term, motor develop-ment stimulates interaction with the environment, resultingin advancing development of various cognitive skills, by cre-ating new learning opportunities.4 Studies in children bornpreterm are scarce, but we can extrapolate from these find-ings. Although perinatal adverse events may disrupt neuronalstructures and connections in the developing brain, affectingboth motor and cognitive brain areas, an alternative hypoth-esis is that certain specific movements and postural patternsduring infancy are required for the infant to develop cogni-tive skills. If these patterns are atypical, abnormal, or absent,cognitive development will be impaired, because of disrup-tions of brain areas involved in motor skills, rather than cog-nition.4 This could also explain the lack of clear associationbetween magnetic resonance imaging findings and later cog-nition in children born preterm.The cause of the coocurring motor and cognitive delaycould be different between children born early pretermand moderate-to-late preterm. With advancing gestationalage, the disruptions of brain development are less severe,but the associations are still moderately strong.1 In linewith this, it has been reported that, in children born mod-erate-to-late preterm, earlier attainment of walking is asso-ciated with good problem-solving skills at 4 years.5 Buteven in children born very preterm, cognitive developmentmay be based on acquiring early motor skills. In the studyby Uusitalo et al., the HINE (at 2y) and cognitive scores(at 11y) were associated 9 years apart, whilst this associa-tion was not found for impaired motor outcomes such asdevelopmental coordination disorder.2The findings in both studies have important clinicalimplications. Lower scores on the HINE may identify chil-dren born preterm at risk for cognitive delay, enablinginterventions aimed at improving later cognition to startearlier than at present. It is tempting to conceive interven-tions that improve certain movements and postures becausethese were the items of the HINE that were associatedmost strongly with attainment of cognitive skills. Whetherthis indeed improves cognition in children born pretermshould be the subject of future longitudinal studies.REFERENCES1. Romeo DM, Cowan FM, Haataja L, et al. HammersmithInfant Neurological Examination for infants born preterm:predicting outcomes other than cerebral palsy. Dev MedChild Neurol 2021. https://doi.org/10.1111/dmcn.14768.2. Uusitalo K, Haataja L, Nyman A, Lehtonen T, Set€anenS, the PIPARI Study Group. The Hammersmith InfantNeurological Examination associates with long-termcognitive outcome in children born very preterm. DevMed Child Neurol 2021. https://doi.org/10.1111/dmcn.14873.3. Einspieler C, Bos AF, Libertus ME, Marschik PB. TheGeneral Movement Assessment helps us to identify pre-term infants at risk for cognitive dysfunction. FrontiersPsychol 2016; 7: 406.4. Oudgenoeg-Paz O, Mulder H Jongmans MJ, van derHam IJM, Van der Stigchel S. The link between motorand cognitive development in children born pretermand/or with low birth weight: a review of current evi-dence. Neurosci Biobehav Rev 2017; 80: 382–93.5. van Dokkum NH, Reijneveld SA, Bos AF, de KroonMLA. Attainment of smiling and walking in infancyassociates with developmental delays at school entry inmoderately-late preterm children: a community-basedcohort study. BMC Pediatr 2021; 21: 84.© 2021 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press. 1This is an open access article under the terms of the Creative Commons Attribution License, which permits use,distribution and reproduction in any medium, provided the original work is properly cited.

   University of GroningenEarly neuromotor performance and later cognition in children born pretermBos, Arend F.Published in:Developmental Medicine and Child NeurologyDOI:10.1111/dmcn.14901IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2021Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Bos, A. F. (2021). Early neuromotor performance and later cognition in children born preterm.Developmental Medicine and Child Neurology, 63(8), 891-891. https://doi.org/10.1111/dmcn.14901CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 29-04-2023DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY COMMENTARYEarly neuromotor performance and later cognition in children bornpretermAREND F BOSUniversity Medical Center Groningen – Beatrix Children’s Hospital, Division ofNeonatology, University of Groningen, Groningen, the Netherlands.doi: 10.1111/dmcn.14901This commentary is on the original articles by Romeo et al. and Uusitaloet al. To view these papers visit https://doi.org/10.1111/dmcn.14768 andhttps://doi.org/10.1111/dmcn.14873.Prediction of neurodevelopmental outcomes after pretermbirth has interested neonatologists and health care workersinvolved in follow-up of children born preterm for decades.Whereas many studies demonstrate evidence regarding pre-diction of childhood outcomes in the motor domain, predic-tion of cognitive skills lags behind. Two new studies add tothis evidence by reporting moderately strong associationsbetween the scores on the Hammersmith Infant Neurologi-cal Examination (HINE) in infancy and cognition lateron.1,2 It is interesting that they report similar results, withthe associations remaining similarly strong after excludingchildren with cerebral palsy (CP) from their analyses. Thefindings in both studies are robust and include the completerange of preterm birth. They encompass the HINE per-formed at 3 to 12 months1 and at 24 months,2 with cognitivedevelopment measured at 2 years1 and 11 years2 respectively.The associations found have also been demonstrated inseveral studies regarding the predictive value of GeneralMovement Assessment (GMA) for later cognition.3 BothHINE and GMA have good predictive value for CP, butassociations with cognition are only moderately strong. Bothinstruments thus enable us to identify risk of cognitive delayat group level, but there is considerable overlap of scoresbetween children with typical and delayed cognitive devel-opment. This may preclude prediction on an individualbasis, as sensitivities between 3 to 12 months vary from 50%to 80%. It would be interesting to investigate whether thecombination of GMA and HINE in young infants wouldincrease the predictive value for later cognition, in line withwhat has been found for prediction of CP.The connection between early findings in the motordomain and later cognitive skills is very interesting. Intypically developing children born at term, motor develop-ment stimulates interaction with the environment, resultingin advancing development of various cognitive skills, by cre-ating new learning opportunities.4 Studies in children bornpreterm are scarce, but we can extrapolate from these find-ings. Although perinatal adverse events may disrupt neuronalstructures and connections in the developing brain, affectingboth motor and cognitive brain areas, an alternative hypoth-esis is that certain specific movements and postural patternsduring infancy are required for the infant to develop cogni-tive skills. If these patterns are atypical, abnormal, or absent,cognitive development will be impaired, because of disrup-tions of brain areas involved in motor skills, rather than cog-nition.4 This could also explain the lack of clear associationbetween magnetic resonance imaging findings and later cog-nition in children born preterm.The cause of the coocurring motor and cognitive delaycould be different between children born early pretermand moderate-to-late preterm. With advancing gestationalage, the disruptions of brain development are less severe,but the associations are still moderately strong.1 In linewith this, it has been reported that, in children born mod-erate-to-late preterm, earlier attainment of walking is asso-ciated with good problem-solving skills at 4 years.5 Buteven in children born very preterm, cognitive developmentmay be based on acquiring early motor skills. In the studyby Uusitalo et al., the HINE (at 2y) and cognitive scores(at 11y) were associated 9 years apart, whilst this associa-tion was not found for impaired motor outcomes such asdevelopmental coordination disorder.2The findings in both studies have important clinicalimplications. Lower scores on the HINE may identify chil-dren born preterm at risk for cognitive delay, enablinginterventions aimed at improving later cognition to startearlier than at present. It is tempting to conceive interven-tions that improve certain movements and postures becausethese were the items of the HINE that were associatedmost strongly with attainment of cognitive skills. Whetherthis indeed improves cognition in children born pretermshould be the subject of future longitudinal studies.REFERENCES1. Romeo DM, Cowan FM, Haataja L, et al. HammersmithInfant Neurological Examination for infants born preterm:predicting outcomes other than cerebral palsy. Dev MedChild Neurol 2021. https://doi.org/10.1111/dmcn.14768.2. Uusitalo K, Haataja L, Nyman A, Lehtonen T, Set€anenS, the PIPARI Study Group. The Hammersmith InfantNeurological Examination associates with long-termcognitive outcome in children born very preterm. DevMed Child Neurol 2021. https://doi.org/10.1111/dmcn.14873.3. Einspieler C, Bos AF, Libertus ME, Marschik PB. TheGeneral Movement Assessment helps us to identify pre-term infants at risk for cognitive dysfunction. FrontiersPsychol 2016; 7: 406.4. Oudgenoeg-Paz O, Mulder H Jongmans MJ, van derHam IJM, Van der Stigchel S. The link between motorand cognitive development in children born pretermand/or with low birth weight: a review of current evi-dence. Neurosci Biobehav Rev 2017; 80: 382–93.5. van Dokkum NH, Reijneveld SA, Bos AF, de KroonMLA. Attainment of smiling and walking in infancyassociates with developmental delays at school entry inmoderately-late preterm children: a community-basedcohort study. BMC Pediatr 2021; 21: 84.© 2021 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press. 1This is an open access article under the terms of the Creative Commons Attribution License, which permits use,distribution and reproduction in any medium, provided the original work is properly cited.

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Early neuromotor performance and later cognition in children born preterm

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