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.
