Early prediction of neurodevelopmental outcomes at 12 years in children born extremely preterm.

Abstract

Extremely preterm (EPT) birth is a major risk factor for neurodevelopmental impairments. The aim was to evaluate the predictive value of Prechtl General Movement Assessment (GMA), including the Motor Optimality Score-Revised (MOS-R), at 3 months corrected age (CA) for adverse neurodevelopmental outcome at the age of 12 years. The GMA, including the MOS-R, was applied at 3 months CA and outcomes were assessed at 12 years by Touwen's neurological examination, the Movement Assessment Battery for Children-2, and chart reviews. Fifty-three infants born EPT (33 boys, mean GA 25 weeks, mean body weight 805 ± 156 g) were included. Forty-two (79%) children participated in the follow-up (mean age 12.3 ± 0.4) and 62% of these had adverse outcomes. The MOS-R differed between groups (p = 0.007). The respective predictive values of GMA, aberrant FMs, and the MOS-R cut-off of 21 for adverse outcomes were positive predictive values (PPVs) of 1.00 and 0.77, negative predictive value of 0.47 and 0.63, sensitivity of 0.31 and 0.77, and specificity of 1.00 and 0.77. Using the Prechtl GMA, including the MOS-R, at 3 months CA predicted an overall adverse neurodevelopment at 12 years, with a high PPV, specificity, and sensitivity in children born EPT. The Prechtl GMA, including the MOS-R, can improve early identification of long-term adverse neurodevelopmental outcomes. This is the first study to investigate the predictive value of the MOS-R for neurodevelopmental outcome at mid-school age in children born EPT. Using the GMA, including the MOS-R, is suggested as one important part of the neurological assessment at 3 months CA in children born EPT. Aberrant FMs in combination with a MOS of <21 is an indicator of an increased risk of future adverse neurodevelopment in children born EPT.