FV 1170. What Influences Motor Function in VLBW Preterm at 5 Years of Age?

Background: Apart from cerebral palsy, very low birth weight (VLBW) preterm born children have a high risk of motor impairment. Neonatal risk factors such as gestational age, Z-score of birth weight, bronchopulmonary dysplasia (BPD), or intraventricular hemorrhage (IVH) have been described before. However, socioeconomic or environmental influences have rarely been studied.

Aim: We wanted to analyze the association of neonatal, parental, and child-related influences on motor outcome of 5-year-old VLBW children.

Participants: VLBW children born in 2009 to 2011 and participating in the German Neonatal Network without cerebral palsy were analyzed.

Methods: Neonatal influences analyzed were gender, gestational age, Z-score of birth weight, BPD, and IVH. For parental influence, we analyzed income below the 60% OECD poverty risk, maternal and paternal education, maternal and paternal sport habits, smoking habits, and smoking during pregnancy and breastfeeding. We further analyzed club sport participation, weight status, lung function, chronic bronchitis, age at starting professional child care and hours spent in child care, and time spent watching TV or playing computer games as possible child-related associations.

Stepwise linear regression was used to analyze the association of the above-mentioned variables with scores of the MABC II after the fifth birthday. Variables with significant influence within the neonatal, parental, and child-related model were included in the final model. Data analysis was repeated using logistic regression for the risk of a pathologic MABC score.

Results: A total of 1,347 VLBW children participated in the 5-year follow-up and in 1,040 (77%), a valid score on the MABC was available. The final linear regression model explained 17% of the variance on MABC scores. Female gender (CoeB [95% CI]: 4.6 [2.7–6.6]), higher Z-score (3.3 [2.2–4.6]), a higher gestational age (1.9 [1.3–2.4]), maternal sport more than once a week (2.6 [0.7–4.6]), and participation of the child in club sport (2.5 [0.4–4.5]) were associated with increased MABC scores, while an impaired lung function decreased the score (−4.2 [−6.4−(−2.1)]). The odds ratio for a pathologic MABC score was associated with a decrease in higher gestational age and higher Z-score of birth weight, and an increase in children starting professional child care at an older age or in impaired lung function.

Interpretation: Neonatal risk factors such as a lower gestational age and dystrophy have an impact on motor function in VLBW children at the age of 5 years. Most socioeconomic or parent-related factors are not relevant after controlling for confounders. For the child-related factors, direction of any association cannot be determined. However, future studies should investigate whether optimal follow-up and treatment of lung function, earlier start of professional child care, or sport club participation might improve motor function in VLBW children.

No conflict of interest has been declared by the author(s).