Division of Neonatology and Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Biotatistics and Epidemiology Unit, RTI International, Research Triangle Park, NC.
J Pediatr. 2020 Oct;225:51-57.e3. doi: 10.1016/j.jpeds.2020.05.048. Epub 2020 May 28.
To determine associations between hand function at age 18-22 months (early) and scores on the Movement Assessment Battery for Children, 2nd edition (MABC) at 6-7 years of age (school age) in extremely preterm children.
Prospective multicenter cohort of 313 extremely preterm children with early hand function assessment and school-age MABC testing. Early hand function was compared with "definite deficits" (MABC <5th percentile) and MABC standard scores. Early hand function was categorized as "no deficit" vs "any deficit." Mixed-effects regression models were used to evaluate the association of early hand function with MABC deficits, controlling for multiple demographic, neonatal, and childhood factors.
Children with early hand function deficits were more likely to have definite school-age deficits in all MABC subtests (Manual Dexterity, Aiming and Catching, and Balance) and to have received physical or occupational therapy (45% vs 26%; P < .001). Children with early hand function deficits had lower Manual Dexterity (P = .006), Balance (P = .035), and Total Test (P = .039) scores. Controlling for confounders, children with early hand function deficits had higher odds of definite school-age deficits in Manual Dexterity (aOR, 2.78; 95% CI, 1.36-5.68; P = .005) and lower Manual Dexterity (P = .031) and Balance (P = .027) scores. When excluding children with cerebral palsy and those with an IQ <70, hand function deficits remained significantly associated with manual dexterity.
Hand function deficits at age 18-22 months are associated with manual dexterity deficits and motor difficulties at school age, independent of perinatal-neonatal factors and the use of occupational or physical therapy. This has significant implications for school success, intervention, and rehabilitative therapy development.
确定 18-22 个月大（早期）手部功能与 6-7 岁儿童运动评估电池第 2 版（MABC）得分之间的关联在极早产儿中。
前瞻性多中心队列研究了 313 名极早产儿，进行了早期手部功能评估和学龄 MABC 测试。早期手部功能与“明确缺陷”（MABC<第 5 百分位）和 MABC 标准得分进行了比较。早期手部功能分为“无缺陷”与“任何缺陷”。使用混合效应回归模型评估早期手部功能与 MABC 缺陷的关联，控制多个人口统计学、新生儿和儿童因素。
早期手部功能缺陷的儿童更有可能在所有 MABC 子测试（手灵巧性、瞄准和接球以及平衡）中出现明确的学龄缺陷，并且更有可能接受物理或职业治疗（45%比 26%；P<.001）。早期手部功能缺陷的儿童手灵巧性（P=.006）、平衡（P=.035）和总测试（P=.039）得分较低。在控制混杂因素后，早期手部功能缺陷的儿童在 MABC 中出现明确学龄缺陷的可能性更高（优势比，2.78；95%置信区间，1.36-5.68；P=.005），手灵巧性（P=.031）和平衡（P=.027）得分较低。当排除脑瘫儿童和智商<70 的儿童时，手部功能缺陷与手灵巧性仍显著相关。
18-22 个月时的手部功能缺陷与学龄时的手灵巧性缺陷和运动困难有关，与围产期-新生儿因素和职业或物理治疗的使用无关。这对学校成功、干预和康复治疗的发展具有重要意义。
