Clinical Bottom Line
How should I apply this information?
This study retrospectively investigated the relationship between perinatal variables and motor performance in children with ELBW without subsequent neurological or cognitive impairment. The authors state that at 1 year, chronic lung disease (CLD) of prematurity and necrotizing enterocolitis (NEC) were predictive of motor performance, whereas at 4 years, there were no predictive perinatal variables, although there was an association with CLD. In addition, no significant changes in motor scores were found between the 1- and 4-year results; however, 50% of the sample had abnormal motor scores at 4 years. Clinically this information may support the need for earlier onset of physical therapy intervention and education for this population. According to the authors, the parents were provided general advice about optimizing their child's development. This raises the question, if specialized intervention and education had been provided during the first year, would there have been a change in motor classification at the 4-year follow-up? No information regarding interventions was provided. Although perinatal variables may not predict motor delays over time, the presence of motor delays may predict ongoing motor delays and therefore warrant an earlier onset of physical or occupational therapy intervention and education.
What should I be mindful about in applying this information?
The NSMDA used as the motor performance measure has been used often for studies of infants born prematurely. However, there are no reference standards for this test and the sensitivity at 1 year has been reported as low, indicating that it “misses” infants and children with motor problems. Of most concern is the large range in the confidence intervals (CIs) for the CLD and NEC odds ratios. A CI assists in interpreting the mean value that is given for these perinatal variables. The very wide range of CIs suggests that the mean value is not very representative and this analysis should be interpreted with caution. One additional caution is that participants in this study were born more than 20 years ago and thus the results may not pertain to infants born more recently.
Stacy M. Menz, PT, DPT, PCS
San Francisco, California
Linda Fetters, PT, PhD, FAPTA
University of Southern California