Motor and Mental Developmental Trajectories in Preterm Children with Very Low Birth Weight during 6 to 36 Months of Age

• Main Authors: Sin-Jie Li, 李欣潔
• Other Authors: Suh-Fang Jeng
• Format: Others
• Language: en_US
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/qt6842

碩士 === 國立臺灣大學 === 物理治療學研究所 === 106 === Background and purpose: Preterm children with very low birth weight (VLBW, birth weight < 1,500 g) are at risk of adverse developmental outcomes that require early identification and intervention of those who will have developmental disorder. Previous follow-up studies mostly examined the average developmental performance in preterm children and rarely explored the variations of developmental progress within population and the potential influencing factors. The purposes of this study were therefore to retrospectively abstract the longitudinal data of our previous cohort studies to examine the mental and motor development trajectories in VLBW preterm children in Taiwan during the first three years of age, to investigate the influencing factors for different trajectories, and to assess the relations of trajectories with developmental outcomes at four years of age. Methods: The perinatal and socio-environmental data were collected in all preterm infants with VLBW at baseline. Their mental and motor development were assessed by the Bayley Scales of Infant Development- Second Edition at 6, 12, 24 and 36 months of age; and the motor, cognitive and behavioral outcomes at 4 years of age were respectively examined using the Movement Assessment Battery for Children- Original or Second Edition, the Wechsler Preschool and Primary Scale of Intelligence, Revised and the Child Behavior Checklist for Ages 1.5-5. Developmental trajectories were examined by the latent growth curve modeling, group-based trajectory modeling and growth mixture modeling sequentially to select a representative model. The relations of developmental trajectories with influencing factors and subsequent outcomes were examined using logistic regression analysis. Results: Preterm children with VLBW showed three mental trajectories: stably normal (64.0%), deteriorating (31.4%) and persistently delayed patterns (4.6%); and four motor trajectories: above average (6.3%), stably normal (60.0%), deteriorating (28.5%) and persistently delayed patterns (5.2%) during 6 to 36 months of age. With respect to the stably normal pattern in mental development, the deteriorating pattern was associated with severe retinopathy of prematurity (ROP) (odds ratio [OR] [95% confidence interval (CI)] = 1.8 [1.3-3.1]), lower paternal educational level (OR [95% CI] = 2.2 [1.3-3.7]) and lower maternal educational level (OR [95% CI] = 1.8 [1.2-2.8]); whereas the persistently delayed pattern was associated with lower birth weight (OR [95% CI] = 0.3 [0.1-0.6]), longer hospital stay (OR [95% CI] = 3.3 [1.5-7.4]), major brain damage (OR [95% CI] = 17.9 [1.7-488.2]), lower paternal educational level (OR [95% CI] = 3.4 [1.5-7.8]) and lower maternal educational level (OR [95% CI] = 2.7 [1.2-60.2]) (all p<0.05). With respect to the above average and stably normal patterns in motor development, the deteriorating pattern was associated with lower birth weight (OR [95% CI] = 0.5 [0.3-0.7]) and paternal occupation status (OR [95% CI] = 2.2 [1.1-4.3]) (both p<0.05); the persistently delayed pattern was associated with severe ROP (OR [95% CI] = 2.7[1.1-6.5]), major brain damage (OR [95% CI] = 10.7 [2.2-50.7]), lower paternal education level (OR [95% CI] = 2.2 [1.0-4.8]) and lower maternal occupation status (OR [95% CI] = 16.7 [2.1-133.6]) (all p<0.05). Furthermore, the deteriorating mental pattern was predictive of mental delay (OR [95% CI] = 11.3 [2.3-55.1], p<0.05); whereas, the persistently delayed mental pattern was predictive of mental delay (OR [95% CI] = 130.6 [33.2-777.0]), motor delay (OR [95% CI] = 18.3 [5.5-60.1]) and internalizing behavioral problem at 4 years of age (OR [95% CI] = 4.3 [1.4-12.6]) (all p < 0.05). In contrast, the deteriorating motor pattern was predictive of mental delay (OR [95% CI] = 3.5 [1.1-11.7], p < 0.05) and motor delay at 4 years (OR [95% CI] = 4.2 [1.8-9.8]); whereas, the persistently delayed motor pattern was predictive of mental delay (OR [95% CI] = 24.6 [6.0-94.0], motor delay (OR [95% CI] = 53.4 [13.5-210.0], and internalizing problem at 4 years (OR [95% CI] = 3.2 [1.2-8.8]) (all p < 0.05). Conclusion: Preterm children with VLBW demonstrated various mental and motor trajectories during 6 to 36 months of age that were associated with certain perinatal and socio-environmental risk factors. Furthermore, the mental and motor trajectories were each predictive of 4-year mental, motor and behavioral outcomes. The study provides insightful information for planning early identification and intervention of preterm children with VLBW in Taiwan.