PEDIATRICS Vol. 123 No. 5 May 2009, pp. e887-e895 (doi:10.1542/peds.2008-0135)
ARTICLE |
Stability of Neuromotor Outcomes at 18 and 30 Months of Age After Extremely Low Birth Weight Status
a Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
b Department of Physical and Occupational Therapy, Children's Hospital of Alabama, Birmingham, Alabama
c Department of Pediatrics, Emory University, Atlanta, Georgia
d RTI International, Research Triangle Park, North Carolina
e Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island
BACKGROUND. Extremely low birth weight (
1000 g) children have increased rates of cerebral palsy and other abnormal neurologic findings.
OBJECTIVE. To investigate the stability of neuromotor findings between 18 and 30 months' adjusted age in extremely low birth weight infants.
METHODS. Seven hundred nineteen extremely low birth weight infants with assessments at 18 and 30 months' adjusted age were included in this analysis. At each visit a neurologic examination, the modified gross motor function classification system, and the Bayley Scales of Infant Development II were administered. Logistic regression models were constructed to assess neonatal factors and neuromotor function at 18 months of age associated with stability in neuromotor function.
RESULTS. Eighty-four percent of the children had agreement in neurologic/motor function at both visits. However, classification changed from normal to abnormal in 6% and from abnormal to normal in 10%. Diagnosis of cerebral palsy was consistent for 91% of the children, and the gross motor function classification system score was consistent for 83%. In multivariate models, factors associated with decreased severity or absence of cerebral palsy diagnosis at 30 months of age were higher gestational age, no periventricular leukomalacia or severe intraventricular hemorrhage, and a gross motor function classification system score of 0 (normal) at the 18-month visit, whereas factors associated with a new cerebral palsy diagnosis at 30 months of age were postnatal steroid use, periventricular leukomalacia or severe intraventricular hemorrhage, a gross motor function classification system score of 
1 at 18 months of age, and asymmetrical limb movement at 18 months of age.
CONCLUSIONS. Stability of neurologic diagnosis in 84% and cerebral palsy in 91% of the children is reassuring. However, for a significant percentage of children, the neurologic diagnosis changes between 18 and 30 months of age. The diagnosis of cerebral palsy may be delayed in some infants until an older adjusted age.
Key Words: neuromotor outcomes • extreme low birth weight • prematurity • cerebral palsy
Abbreviations: ELBW—extremely low birth weight • CP—cerebral palsy • GMFCS—gross motor function classification system • MDI—Mental Developmental Index • PDI—Psychomotor Developmental Index • NICHD—Eunice Kennedy Shriver National Institute of Child Health and Human Development • NPV—negative predictive value • PPV—positive predictive value • DTR—deep tendon reflexes • SES—socioeconomic score • IVH—intraventricular hemorrhage • PVL—periventricular leukomalacia
Accepted Jan 13, 2009.
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