Extremely preterm children without cerebral palsy still face high rates of motor difficulty at 12

Design

Population-based national cohort

Population

268 children born before 27 weeks without cerebral palsy or severe impairment, and 196 term-born controls, in Sweden

Primary outcome

Significant motor difficulties (MABC-2 at or below the 5th percentile) at 12 years

Effect

30% vs 3%; adjusted OR 16.99 (95% CI 6.64–43.47)

The Extremely Preterm Infants in Sweden Study assessed motor function at 12 years in children born before 27 weeks between 2004 and 2007, excluding those with cerebral palsy or severe neurodevelopmental impairment, and compared them with term-born peers using the Movement Assessment Battery for Children.

Thirty per cent of the 268 extremely preterm children had significant motor difficulties — at or below the fifth percentile — against 3% of 196 controls (adjusted OR 16.99, 95% CI 6.64–43.47). Boys and those born at the lowest gestations were at greatest risk. Autism and ADHD were common among affected children. Only 9.5% of those with difficulties had seen a physiotherapist in the previous year.

These are children whom structured follow-up often discharges once cerebral palsy has been excluded in early childhood. The findings argue for asking about coordination, handwriting and sport at school age, and for looking for attention and social difficulties alongside. The cohort is Swedish, where neonatal care and follow-up are well resourced; comparable Indian data were not part of this study.

• Ask about coordination, handwriting and sport at every school-age review of a child born extremely preterm.
• Do not discharge from follow-up simply because cerebral palsy has been ruled out.
• Consider referral for physiotherapy or occupational therapy when motor difficulties affect school or play.
• Screen for attention and social communication difficulties, which often travel with motor problems.
• Pay particular attention to boys and those born at the lowest gestations.

Why it matters

Ruling out cerebral palsy has been treated as the end of motor follow-up, and this shows it should not be.

Don't overread it

This cohort shows how common difficulties are, not that physiotherapy at 12 would correct them.

The statistics, in plain English

An adjusted odds ratio of 17 is very large, but the 95% confidence interval (6.6 to 43.5) is wide because so few term-born children had difficulties. The absolute figures — 30% against 3% — are the clearer way to describe it.

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