Developmental Coordination Disorder and Its Association With Developmental Comorbidities at 6.5 Years in Apparently Healthy Children Born Extremely Preterm

Abstract

<div class="section"> <a class="named-anchor" id="ab-poi180032-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d806118e313">Question</h5> <p id="d806118e315">How common are motor impairments that interfere with daily life and associated comorbidities at early school age in apparently healthy children who are born extremely preterm? </p> </div><div class="section"> <a class="named-anchor" id="ab-poi180032-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d806118e318">Findings</h5> <p id="d806118e320">This national cohort study found that more than one-third of children who were born extremely preterm in the modern neonatal era had developmental coordination disorder at 6.5 years of uncorrected age, which was associated with considerable adaptive behavioral and perceptual problems and worse cognition. </p> </div><div class="section"> <a class="named-anchor" id="ab-poi180032-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d806118e323">Meaning</h5> <p id="d806118e325">Motor impairments are common at early school age in children who are born extremely preterm and are associated with several comorbidities, which is important for clinicians planning and implementing follow-up programs. </p> </div><div class="section"> <a class="named-anchor" id="ab-poi180032-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d806118e329">Importance</h5> <p id="d806118e331">There are concerns that apparently healthy extremely preterm children face a risk of developing motor impairments, such as developmental coordination disorder. </p> </div><div class="section"> <a class="named-anchor" id="ab-poi180032-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d806118e334">Objective</h5> <p id="d806118e336">To evaluate the prevalence of developmental coordination disorder and associated comorbidities in a national cohort of apparently healthy children born at 22 to 26 gestational weeks, compared alongside term-born peers. </p> </div><div class="section"> <a class="named-anchor" id="ab-poi180032-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d806118e339">Design, Setting, and Participants</h5> <p id="d806118e341">This prospective, population-based cohort study included all children who were consecutively born at 22 to 26 gestational weeks in Sweden from April 1, 2004, through March 31, 2007. At 6.5 years, 441 preterm children were evaluated alongside 371 controls. A total of 275 preterm children (62.4%) and 359 term-born children (96.8%) did not have neurodevelopmental disabilities. Motor assessments were completed for 229 of 275 preterm children (83.3%) and 344 of 359 (95.8%) term-born children, who composed the final study sample. </p> </div><div class="section"> <a class="named-anchor" id="ab-poi180032-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d806118e344">Main Outcomes and Measures</h5> <p id="d806118e346">Developmental coordination disorder was defined as a score of the fifth percentile or lower on the Movement Assessment Battery for Children–Second Edition scale, using control group scores. Assessment tools included the Wechsler Intelligence Scale for Children-Fourth Edition, the Brown Attention-Deficit Disorder Scales, the Five to Fifteen questionnaire, and the Strengths and Difficulties questionnaire. </p> </div><div class="section"> <a class="named-anchor" id="ab-poi180032-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d806118e349">Results</h5> <p id="d806118e351">Of the 229 extremely preterm children and 344 term-born controls who underwent motor assessments, 115 (50.2%) and 194 (56.4%) were boys, respectively. Developmental coordination disorder was present in 85 of 229 (37.1%) preterm children and in 19 of 344 controls (5.5%) (adjusted odds ratio [OR], 7.92; 99% CI, 3.69-17.20). When preterm children with developmental coordination disorder were compared with term-born peers, the risk was increased for total behavioral problems, internalizing, externalizing, attentional problems, hyperactivity, perceptual problems, executive dysfunction, and poor social skills, with adjusted ORs varying from 2.66 (99% CI, 1.09-6.48) for time concepts to 9.06 (99% CI, 3.60-22.8) for attentional problems (all <i>P</i> &lt; .01). When preterm children with and without developmental coordination disorder were compared, preterm children with developmental coordination disorder had more behavioral problems; the adjusted OR for total behavioral problems was 2.71 (99% CI, 1.15-6.37); for externalizing problems, 2.80 (99% CI, 1.10-7.12); for inattention, 3.38 (99% CI, 1.39-8.18); and for combined attention/hyperactivity problems, 3.68 (99% CI, 1.47-9.16) (all <i>P</i> &lt; .01). Parents underestimated the children’s motor problems and only a few of the children had received psychological care or physiotherapy. </p> </div><div class="section"> <a class="named-anchor" id="ab-poi180032-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d806118e360">Conclusions and Relevance</h5> <p id="d806118e362">Children who were born extremely preterm faced a high risk for developmental coordination disorder with associated comorbidities. Our findings support the importance of a structured follow-up of motor function, behavior, and cognition. </p> </div><p class="first" id="d806118e365">This cohort study assesses the prevalence of developmental coordination disorder and its association with developmental comorbidities at 6.5 years in children without major disabilities who were born extremely preterm in the 2000s and were part of the EXPRESS study. </p>