733 - Early motor developmental concerns at 3-6 months corrected gestational age across the New England Follow-up Network

Publication Number: 2715.733

Deirdre O'Reilly, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Samantha R. Dunn, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Erika M. Edwards, Vermont Oxford Network, Burlington, VT, United States; Leslie S.. Kerzner, Harvard Medical School, Lynnfield, MA, United States; Elisabeth McGowan, Women & Infants Hospital of Rhode Island, Providence, RI, United States; Charles Mercier, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States

Background: Early diagnosis of motor delays in extremely low birth weight (ELBW) infants is critical for evidence-based interventions, which can improve functional outcomes by leveraging neuroplasticity in the developing brain. Early identification facilitates family engagement and access to resources, while minimizing the uncertainty and stress associated with delayed diagnosis1. The New England Follow-up Network (NEFUN), in collaboration with Vermont Oxford Network (VON), assessed motor concerns among ELBW infants at 3-6 months corrected gestational age (CGA).

Objective: To assess early motor developmental concerns among ELBW infants between 3-6m CGA through standardized follow-up across the NEFUN.

Design/Methods: Infants born between 2022-24 at either < 28 weeks gestational age or < 1000 grams and in NEFUN centers contributed data to the VON ELBW Follow-up Database. Outcomes assessed included follow-up rate at 3-6m CGA, Ages and Stages-3 (ASQ-3) developmental screens completed by caregivers, clinical assessment, and active therapy intervention at the time of assessment. We report the NEFUN center follow-up rates at the median (25th, 75th) percentiles and percentages at the infant level.

Results: Seven NEFUN centers collected 3-6m CGA follow up data. Among 709 eligible infants, 472 (66.5%) were assessed. The median center follow-up rate was 74.2% (51.9%, 97.6%), with a 6.4% increase to 80.6% (57.4%, 100%) over the 3-year period.
Of the 271 infants with a completed ASQ-3, 33.7% had gross motor concerns and 30.9% had fine motor concerns. Appraisal of 121 infants by clinicians alone found 24.0% with motor concerns. The median follow-up program rate of occupational therapy (OT) or physical therapy (PT) services was 61% (52.4%, 78.0%). Of 176 infants identified with a gross or fine motor concern by clinical or caregiver appraisal, 117 (66.5%) were referred to OT or PT services.

Conclusion(s): Standardized and validated assessment at 3-6m CGA provided vital information for this population of ELBW infants at risk for motor developmental delays. Clinical appraisal by a clinician alone endorsed a lower level of infant motor concerns than was reported on caregiver screening questionnaire. While over 66% of infants with motor concerns were referred to OT or PT services, infants not referred could be without services that enhance motor development and aid with diagnosis of cerebral palsy. NEFUN centers will use the results of this study to target strategies to ensure optimal resources are in place to improve early detection of motor developmental delays as well as access to therapy services.

Table 1
Identification of motor delays by appraisal type

Table 2
Referral for services among infants with identified gross or fine motor issue by appraisal type