Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France.
EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal.
Pediatrics. 2022 Jun 1;149(6). doi: 10.1542/peds.2021-054920.
Children born extremely preterm (EPT), <28 weeks' gestational age, face higher risks of movement difficulties than their term-born peers. Studies report varying prevalence estimates and prognostic factors identifying children who could benefit from early intervention are inconsistent. This study investigated the prevalence of movement difficulties in children born EPT and associated risk factors.
Data come from a population-based EPT birth cohort in 2011 and 2012 in 11 European countries. Children without cerebral palsy were assessed at 5 years of age (N = 772) with the Movement Assessment Battery for Children-Second Edition, which classifies movement difficulties as none (>15th percentile), at risk (6th-15th percentile) and significant (≤5th percentile). Associations with sociodemographic, perinatal, and neonatal characteristics collected from obstetric and neonatal medical records and parental questionnaires were estimated using multinomial logistic regression.
We found 23.2% (n = 179) of children were at risk for movement difficulties and 31.7% (n = 244) had significant movement difficulties. Lower gestational age, severe brain lesions, and receipt of postnatal corticosteroids were associated with significant movement difficulties, whereas male sex and bronchopulmonary dysplasia were associated with being at risk and having significant movement difficulties. Children with younger, primiparous, less educated, and non-European-born mothers were more likely to have significant movement difficulties. Differences in prevalence between countries remained after population case-mix adjustments.
This study confirms a high prevalence of movement difficulties among EPT children without cerebral palsy, which are associated with perinatal and neonatal risk factors as well as sociodemographic characteristics and country.
极早产儿（<28 周胎龄）在运动方面面临着比足月出生的同龄人更高的困难风险。研究报告了不同的患病率估计值，且识别可能受益于早期干预的儿童的预后因素也不一致。本研究调查了极早产儿中运动困难的患病率及其相关的危险因素。
数据来自于 2011 年和 2012 年在 11 个欧洲国家开展的一项基于人群的极早产儿出生队列研究。共有 772 名无脑瘫的儿童在 5 岁时接受了儿童运动评估测试第二版（Movement Assessment Battery for Children-Second Edition）评估，该测试将运动困难分为无（>第 15 百分位数）、有风险（第 6-15 百分位数）和显著（≤第 5 百分位数）三种情况。通过多变量逻辑回归分析，评估了从产科和新生儿医疗记录以及家长问卷中收集到的与社会人口统计学、围产期和新生儿特征相关的因素与运动困难之间的关联。
我们发现，23.2%（n=179）的儿童有运动困难风险，31.7%（n=244）有显著运动困难。较低的胎龄、严重的脑损伤和接受产后皮质类固醇治疗与显著的运动困难有关，而男性性别和支气管肺发育不良与有风险和显著运动困难有关。母亲年龄较小、初产妇、受教育程度较低和非欧洲出生的儿童更有可能有显著的运动困难。在调整人口病例组合后，各国之间的患病率差异仍然存在。
本研究证实了无脑瘫的极早产儿中运动困难的高患病率，其与围产期和新生儿危险因素以及社会人口统计学特征和国家有关。
