Predictive role of early milestones-related psychomotor profiles and long-term neurodevelopmental pitfalls in preterm infants. (October 2016) - Di Rosa, Gabriella
Abstract: Background: Developmental milestones are useful signposts developed to assess the pace and the trajectory of maturation occurring during specific time-windows called critical periods . The predictive role of their clinical assessment in premature infants is challenging, however, it actually represents an easy and reliable tool at follow-up. Aim and study design: Relying on a milestone-based neurological examination, we aimed to detect the interdependence between time of achievement of each milestone with long-term neuropsychological and neurodevelopmental outcomes. The influence of pre-perinatal events was also considered. Patients & methods: Two-hundred-eighty patients (53.2% M) were serially assessed by classic neurological examination during the first 18 months and subsequently evaluated by Griffiths Developmental Mental Scale. Children were sorted by ranges of gestational age and compared according to their different profiles. Results: The Extremely PreTerms appeared to have a globally delayed development with subsequent attentional and behavioral troubles. Differently, the older peers, from Moderately to Full Term ones, although did not show significant differences in achievement of gross motor skills, had a stable delay of visual and social skills across the age ranges. This gap was not evidenced at the long-term evaluation, except for the Extremely PreTerm children. Pre-perinatal factors played a significant role on short and long term neurodevelopmental outcome. Conclusions: Early assessed classic neurological examination might address neurodevelopmental trajectories in PreTerm children in which visual and social skills appear to be the mostly affected. It remains the easiest and most reliable tool of evaluation throughout the follow-up programs. Highlights: The predictive role of clinical assessment of developmental milestones in premature infants is challenging. Chronological age might identify the exact, prematurity-dependent, neuromotor and neurobehavioral gap and the time point when the adaptive developmental trajectory of the PreTerm groups would take similar direction of the Full Term ones, if it would. The Extremely PreTerm group showed globally delayed developmental milestones respect to the older groups, remaining stable over time. About gross motor skills, developmental gap was progressively disappearing across the groups up to Moderate PreTerm and Late PreTerm compared to the Full Term ones, and to Late PreTerm, Early Term and Full Term, that showed similar motor development profiles. The gap was not evidenced at the long-term evaluation by the GMDS except for the EPT children.