General Movements and Outcome in Children with Birthweights ≤ 500 Grams at Age 5 to 6 Years

Background: The prognosis of long-term outcome in the delicate subgroup of preterm infants born with a birthweight ≤ 500 g is difficult. We wanted to determine whether general movements (GMs) correlate with outcome at 5 to 6 years of age in preterm children with birthweights ≤500 g.

Methods: GMs were assessed up to 20 weeks postterm age in a cohort of infants born consecutively in our unit between 1998 until 2003. A structured neurological examination, the Gross Motor Function Classification Scale, and the Kaufman Assessment Battery Test for Children were applied in surviving children at 5 to 6 years. In relation to long-term outcome, only the postterm GM assessment was analysed.

Results: Of 44 infants in total, 19 received immediate life support in the delivery room and were admitted to the NICU (GA 25 weeks [22.3-29.5]; BW 440 g [334-490]). All 9 surviving infants received GM assessment, but only 8 out of 9 infants had postterm assessment; all 9 had outcome assessment at 5 to 6 years. Children with female sex and birthweights>400 g had better outcomes than those with male sex and birthweights < 400 g. Normal fidgety movements and normal repertoire were associated with normal development at early school age in 3 children, in one child with moderate cognitive impairment and light motor impairment. Pathological fidgety movements or repertoire were associated with abnormal motor development and moderate and severe cognitive impairment in 3 children and with normal development in one child.

Conclusion: This study shows that normal fidgety movements at postterm age combined with birthweight and sex may predict normal motor and cognitive outcome in extremely preterm children with birthweights ≤500 g.