742 - Motor trajectories, motor delays and Cerebral Palsy in infants born ≤ 23 weeks gestation: the importance of early and continued surveillance

Publication Number: 2724.742

Nathalie L. Maitre, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, United States; William Kjeldsen, Emory University School of Medicine, Tucker, GA, United States; Salathiel Renee'. Kendrick-Allwood, Emory University School of Medicine and Children's Healthcare of Atlanta, Mableton, GA, United States; Kanishka Baduni, University if Georgia, Omaha, NE, United States; Ashley Y. Kim, Emory University School of Medicine, Atlanta, GA, United States; Katherine G. Bragg, Emory University School of Medicine, Edina, MN, United States; Lucas E. Koh-Maitre, Georgia Institute of Technology, Atlanta, GA, United States; Mary Lauren Neel, Emory University School of Medicine, Atlanta, GA, United States

Background: Infants surviving after preterm birth ≤ 23 weeks gestation (GA) represent an increasing proportion of those cared for in NICU follow-up programs. While one perspective might predict their morbidity, another, supported by caregivers of children with disabilities, focuses on effective surveillance to improve outcomes and offer hope. Motor delays and impairments are increasingly treatable early on, as evidenced by systematic reviews (McNamara 2022, Morgan 2020).

Objective: We aimed to investigate motor outcomes of infants born <= 23 weeks GA, by studying motor scores, motor trajectories and cerebral palsy (CP) in a large and diverse cohort.

Design/Methods: Single site retrospective study of 219 infants born <= 23 weeks GA (2015-2025) cared for in a regional NICU-follow-up program. Bayley Scales of Infant and Toddler Development (3d and 4th ed.) were performed with standardization verified by Neonatal Research Network gold standards in the first three years. Those with motor impairments precluding standardized testing received questionnaires. In 2021 a systematic early CP detection program was implemented. Descriptive statistics and linear mixed models with repeated measures evaluating change over time were conducted in R.

Results: Of 219 children (21 weeks N=2, 22 weeks N=44, 23 weeks N=153), 105 (48%) were female and 52% black/aa. CP was confirmed in 106 (48%) with another 14 (6%) currently high-risk for CP - 30% of those with CP were not testable. Average CP diagnosis age was 25 months Corrected Age (CA) before, and 11.7 months after instituting CP early detection guidelines (p < 0.01). Overall, 193 children had at least one Bayley, and 35 had >1. Of those with Bayleys, 73% had motor scores < 1SD below the mean. Cross-sectional average cohort scores for fine (FM) and gross motor (GM) scales remained below average (10) between 9 and 39 months CCA (Figure 1A&B). Trajectories of the sub-cohort (Fig 2A&B) with repeat Baileys showed FM scores decreased by 0.11 points (p=0.01) per 1 month elapsed after initial testing and GM scores by 0.06 points (p=0.03).

Conclusion(s):

Discussion: In our region, infants born ≤ 23 weeks GA had significant motor delays and impairments. High rates of CP and decreasing scores over the first three 3 years underscore the importance of continued vigilance to correct improve trajectories. Early detection of delays and impairments was possible, supporting referral to evidence-based interventions in the community and to new research studies. Implementation of standardized tools and algorithms is now changing surveillance for these children and we anticipate will soon improve their outcomes.

Figure 1. Bayley Fine Motor (A) and Gross Motor (B) scaled score distribution by testing age
Fig1 PAS NM.pdfAverage is 10; standard deviation 3.

Figure 2 Trajectories of Fine Motor (B) and Gross Motor (B) Bayley scaled scores
Fig2 PAS NM.pdfEach gray line represents the trajectory of an individual child. The bold line represents the average trajectory.Average is 10; standard deviation 3.