Prediction of movement difficulties at age five from parent report at age two in children born extremely preterm

Aim

To assess the predictive validity of parent-reported gross motor impairment (GMI) at age 2 years to detect significant movement difficulties at age 5 years in children born extremely preterm.

Method

Data were from 556 children (270 males, 286 females) born at less than 28 weeks' gestation in 2011 to 2012 in 10 European countries. Parent report of moderate/severe GMI was defined as walking unsteadily or unable to walk unassisted at 2 years corrected age. Examiners assessed significant movement difficulties (score ≤ 5th centile on the Movement Assessment Battery for Children, Second Edition) and diagnoses of cerebral palsy (CP) were collected by parent report at 5 years chronological age.

Results

At 2 years, 66 (11.9%) children had moderate/severe GMI. At 5 years, 212 (38.1%) had significant movement difficulties. Parent reports of GMI at age 2 years accurately classified CP at age 5 years in 91.0% to 93.2% of children. Classification of moderate/severe GMI at age 2 years had high specificity (96.2%; 95% confidence interval 93.6–98.0) and positive predictive value (80.3%; 68.7–89.1) for significant movement difficulties at age 5 years. However, 74.5% of children with significant movement difficulties at 5 years were not identified with moderate/severe GMI at age 2 years, resulting in low sensitivity (25.1%; 19.4–31.5).

Interpretation

This questionnaire may be used to identify children born extremely preterm who at age 2 years have a diagnosis of CP or movement difficulties that are likely to have a significant impact on their functional outcomes at age 5 years.

Graphical Abstract

Parent reported motor impairment at age 2 years accurately classified movement difficulties at age 5 years in 68% to 69% of children. Specificity was very high for predicting motor function in the average range at age 5 years from parent report of no moderate/severe gross motor impairment (GMI) at age 2 years. Positive predictive value was also high, indicating that about 80% of children with moderate/severe GMI at age 2 years had significant movement difficulties at age 5 years. However, sensitivity was relatively low, which resulted in under-identification of children at age 2 years who had significant movement difficulties at age 5 years.