Article

Children born very preterm are at risk for impaired motor performance
ranging from cerebral palsy (CP) to milder abnormalities, such as developmental
coordination disorder. White matter abnormalities (WMA) at term have been
associated with CP in very preterm children; however, little is known about the
impact of WMA on the range of motor impairments. The aim of this study was to
assess whether WMA were predictive of all levels of motor impairments in very
preterm children. METHOD: Two hundred and twenty-seven very preterm infants (< 30
wks gestational age or birthweight < 1250 g) had brain magnetic resonance imaging
at term-equivalent age to assess for WMA, which were categorized as nil, mild, or
moderate to severe. At 5 years of age children were classified as having a
moderate to severe motor impairment if they were below the 5th centile or mild to
severe motor impairment if their score placed them no higher than the 15th
centile on the Movement Assessment Battery for Children (MABC). WMA (nil vs mild
and nil vs moderate-severe) were explored as predictors of motor impairment using
logistic regression. Analyses were repeated adjusting for the effects of other
perinatal variables and excluding children with CP. RESULTS: Of the 193 very
preterm children (97 males, 96 females) assessed with the MABC, 53 (27%) were
classified as having a moderate to severe motor impairment and 96 (50%) a mild to
severe motor impairment. WMA were predictive of motor impairment in very preterm
children, with mild versus no WMA increasing the odds of moderate to severe motor
impairment by over fivefold (odds ratio [OR] 5.6; 95% confidence interval [CI]
1.9-16.1; p=0.002) and mild to severe impairment by twofold (OR 2.2; 95% CI
1.1-4.2; p=0.02). Compared with no WMA, moderate to severe WMA increased the odds
for moderate to severe impairment 19-fold (OR 19.4; 95% CI 5.6-66.7; p<0.001) and
for mild to severe motor impairment ninefold (OR 9.4; 95% CI 3.2-28.1; p<0.001).
Results remained similar after controlling for several potential confounders and
after excluding 14 children who had CP at age 2 years. INTERPRETATION: WMA
predict motor impairment at 5 years, with rates of impairment increasing with
more severe WMA. Very preterm children with any WMA at term require follow-up
throughout childhood.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2011 Mac Keith
Press.

Langue : ANGLAIS