Janssen Anjo J W M, Fleurkens-Peeters Maria J A J, Akkermans Reinier P, Baldew Se-Sergio M, Nijhuis-van der Sanden Maria W G, Zijlmans Wilco C W R
Pediatric Physical Therapy, Department of Rehabilitation, Amalia Children's Hospital, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
Pediatric Physical Therapy, Department of Rehabilitation, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname.
Children (Basel). 2025 Mar 26;12(4):414. doi: 10.3390/children12040414.
Follow-up studies in very preterm infants are common, but fewer studies are situated in low- or middle-income countries. In a prospective cohort study, we explored longitudinal motor performance trajectories and influencing factors, including an early motor intervention program. Very preterm infants (gestational age < 32 weeks and/or very-low-birth-weight < 1500 g) in the middle-income country of Suriname were included. We assessed 149 (49.7% boys) infants (mean gestational age 29, mean birth weight 1271 g) at 3, 12, and 24 months with the Bayley Scales of Infant and Toddler Development for fine motor (FM), gross motor (GM), and composite scores (CSs). Influencing perinatal and environmental factors were explored. Delayed-scoring infants were referred to a motor intervention program. Data were analyzed using mixed-model linear regression. The Bayley mean FM and GM scores decreased between 3 and 12 months and stabilized at 24 months. The mean CS at 3, 12, and 24 months was 102.3, 92.7, and 92.2, respectively. The latter two were significantly below the reference values (100, SD 15, < 0.01). Birth weight z-scores significantly influenced FM ( = 0.013) and CS ( = 0.009); a lower birth weight was associated with initially lower scores and a smaller decline over time than a higher birth weight. The motor intervention program ( = 54) showed no significant interaction effects at all time points after correction for frequency of interventions (no; 1-5; >5 interventions). Motor performance was normal at 3 months and delayed at 12 and 24 months. Birth weight, but not the early intervention program, influenced longitudinal motor trajectories. We recommend follow-up of motor performance and suggest adding the Prechtl General Movement assessment at 3 months of age. The clinical implementation of the early motor invention program needs additional studies to reach an adequate training level.
对极早产儿的随访研究很常见，但在低收入或中等收入国家开展的此类研究较少。在一项前瞻性队列研究中，我们探讨了纵向运动表现轨迹及影响因素，其中包括一项早期运动干预计划。研究纳入了苏里南这个中等收入国家的极早产儿（胎龄<32周和/或出生体重极低<1500克）。我们在3个月、12个月和24个月时，使用贝利婴幼儿发展量表对149名婴儿（49.7%为男孩，平均胎龄29周，平均出生体重1271克）进行精细运动（FM）、大运动（GM）和综合评分（CSs）评估。同时探究了围产期及环境影响因素。对评分延迟的婴儿转介至一项运动干预计划。数据分析采用混合模型线性回归。贝利FM和GM平均评分在3至12个月间下降，并在24个月时稳定。3个月、12个月和24个月时的平均CS分别为102.3、92.7和92.2。后两者显著低于参考值（100，标准差15，<0.01）。出生体重Z评分对FM（=0.013）和CS（=0.009）有显著影响；出生体重较低与最初较低的评分相关，且随时间推移的下降幅度小于出生体重较高者。在对干预频率进行校正后（无；1 - 5次；>5次干预），运动干预计划（=54）在所有时间点均未显示出显著的交互作用。运动表现在3个月时正常，在12个月和24个月时延迟。出生体重而非早期干预计划影响纵向运动轨迹。我们建议对运动表现进行随访，并建议在3月龄时增加普雷茨尔全身运动评估。早期运动干预计划的临床实施需要更多研究以达到足够的训练水平。
