Neurobehavioural Development of Infants Born <30 Weeks Gestational Age Between Birth and Five Years of Age
Condition: Preterm Infant; Motor Activity; Neurodevelopmental Disorders; Developmental Coordination Disorder
MeSH terms: Neurodevelopmental Disorders; Motor Skills Disorders
Study type: Observational

Summary: 
      Research question: The primary aim of this study is to compare the prevalence of motor
      impairment from birth to five years of age between children born <30 weeks and term-born
      controls, and to determine whether persistent abnormal motor assessments in the newborn
      period in those born <30 weeks predict abnormal motor functioning at age five years.
      Secondary aims for both children born<30 weeks and term children are i) to determine whether
      novel early magnetic resonance imaging (MRI) - based structural or functional biomarkers are
      detectable in the neonatal period that can predict motor impairments at five years, ii) to
      investigate the association between motor impairments and concurrent deficits in body
      structure and function at five years of age, and iii) to explore how motor impairments at
      five years, including abnormalities of gait, postural control and strength, are associated
      with concurrent functional outcomes including physical activity, cognitive and learning
      ability, behavioural and emotional problems.

      Design: Prospective longitudinal cohort study. Participants and Setting: 150 preterm children
      (born <30 weeks) and 151 term-born children (born >36 completed weeks' gestation and
      weighing>2499 g) admitted to the Royal Women's Hospital, Melbourne, were recruited at birth
      and will be invited to participate in a five-year follow-up study.

      Procedure: This study will examine previously collected data (from birth to two years) that
      comprises the following: detailed motor assessments and structural and functional brain MRI
      images. At five years, preterm and term children will be examined using comprehensive motor
      assessments including the Movement Assessment Battery for Children - 2nd edition and measures
      of gait function through spatiotemporal (assessed with the GAITRite® Walkway), dynamic
      postural control (assessed with Microsoft Kinect) variables and hand grip strength (assessed
      with a dynamometer); and measures of physical activity (assessed using accelerometry),
      cognitive development (assessed with Wechsler Preschool and Primary Scale of Intelligence)
      and emotional and behavioural status (assessed with the Strengths and Difficulties
      Questionnaire and the Developmental and Wellbeing Assessment). Caregivers will be asked to
      complete questionnaires on demographics, physical activity, activities of daily living and
      motor function (assessed with Pediatric Evaluation of Disability Inventory, Pediatric Quality
      of Life Questionnaire, the Little Developmental Co-ordination Questionnaire and an activity
      diary) at the 5 year assessment.

      Analysis: For the primary aim the prevalence of motor impairment from birth to 5 years will
      be compared between children born <30 weeks and term-born peers using the proportion of
      children classified as abnormal at each of the time points (term age, one, two and five
      years). Persistent motor impairments during the neonatal period will be assessed as a
      predictor of severity of motor impairment at 5 years of age in children born <30 weeks using
      linear regression. Models will be fitted using generalised estimating equations with results
      reported using robust standard errors, to allow for the clustering of multiple births.

      Discussion/Significance: Understanding the developmental precursors of motor impairment in
      children born <30 weeks is essential to limit disruption to skill development, and potential
      secondary impacts on physical activity, participation, academic achievement, self-esteem and
      associated outcomes, such as obesity, poor physical fitness and social isolation. Better
      understanding of motor skill development will enable targeting of intervention and
      streamlining of services to the individuals who are at highest risk of motor impairments.
    


Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Preterm infants <30 weeks' GA at birth admitted to one of the neonatal nurseries at the
        Royal Women's Hospital in Melbourne, Australia.