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. 2024 Aug:271:114037.
doi: 10.1016/j.jpeds.2024.114037. Epub 2024 Apr 4.

Cerebral Palsy and Motor Impairment After Extreme Prematurity: Prediction of Diagnoses at Ages 2 and 10 Years

Timothy Marinelli  1 , Joe X Yi  2 , T Michael O'Shea  2 , Robert M Joseph  3 , Stephen R Hooper  2 , Karl C K Kuban  4 , Christina Sakai  5 , Michael E Msall  6 , Rebecca Fry  7 , Rachana Singh  8 ; ELGAN-ECHO Study Investigators
Collaborators, Affiliations

Cerebral Palsy and Motor Impairment After Extreme Prematurity: Prediction of Diagnoses at Ages 2 and 10 Years

Timothy Marinelli et al. J Pediatr. 2024 Aug.

Abstract

Objective: To identify perinatal factors in children born extremely preterm (EP) that were associated with motor impairment (MI) at 2 and 10 years of age and develop a predictive algorithm to estimate the risk of MI during childhood.

Study design: Participants of the Extremely Low Gestational Age Newborns Study (ELGANS) were classified as: no MI, MI only at 2 years, MI only at 10 years, and MI at both 2 and 10 years, based on a standardized neurological examination at 2 and the Gross Motor Function Classification System (GMFCS) at 10 years of age. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to develop the final predictive model.

Results: Of the 849 study participants, 64 (7.5%) had a diagnosis of MI at both 2 and 10 years and 63 (7.4%) had a diagnosis of MI at 1 visit but not the other. Of 22 total risk factors queried, 4 variables most reliably and accurately predicted MI: gestational age, weight z-score growth trajectory during neonatal intensive care unit (NICU) stay, ventriculomegaly, and cerebral echolucency on head ultrasound. By selecting probability thresholds of 3.5% and 7.0% at ages 2 and 10, respectively, likelihood of developing MI can be predicted with a sensitivity and specificity of 71.2%/72.1% at age 2 and 70.7%/70.7% at age 10.

Conclusion: In our cohort, the diagnosis of MI at 2 years did not always predict a diagnosis of MI at 10 years. Specific risk factors are predictive of MI and can estimate an individual infant's risk at NICU discharge of MI at age 10 years.

Keywords: cerebral palsy; extremely low gestational age newborns; extremely preterm; gross motor function classification system; motor impairment.

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Conflict of interest statement

Declaration of Competing Interest The authors have no financial relationships or any other conflicts of interest relevant to this article to disclose. This study was supported by the National Institute of Neurological Disorders and Stroke (grants 5U01NS040069-05 and 2R01NS040069-09) and the Office of the Director of the National Institutes of Health (1UG3OD023348-01).

Figures

Figure 1.
Figure 1.
Predictability of Gross Motor Function Level ≥2 at Age 2 years and 10 years.
See this image and copyright information in PMC

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