The influence of postural control on motility and hand function in a groupof 'high risk' preterm infants at 1 year of age

The functional outcome of a group of 75 'high-risk' preterm infants was stu died at the corrected age of 12 months. Only infants with high-risk for dev elopmental deviance with gestational ages below 32 weeks and/or birthweight s less than 1500 g were included in the study. Additionally the infants wer e categorised according to their medical history conforming with the 'Neona tal Medical Index' (NMI I to V), with category I describing infants with fe w medical problems and V characterizing those with the most serious complic ations. In this study we included only infants with 'high-risk' as categori sed in NMI III to V, since infants with 'low-risk' have been described earl ier. Infants with cerebral ultrasonographic abnormalities were incorporated into the NMI categories, but also analysed separately to compare outcomes. At 12 months (corrected age) apart from pediatric follow-up, a full neurol ogical assessment was done with emphasis on postural control, spontaneous m otility and hand function. Special attention was given to symmetrical devel opment. The infants were then categorised as having optimal, non-optimal or asymmetrical outcomes. An overall optimal outcome on postural control was found in 64% of all infants (67% in NMI III, 60% in NMI IV and 62.5% in NMI V). Too much extension interfering with postural control was found signifi cantly more often in infants in NMI V (15%), compared to infants in NMI IV (8%) and NMI III (4.5%). Poor postural control had a significant influence on other domains of development such as motility (P = 0.00), asymmetry (P = 0.00) and hand function (P = 0.00). Cerebral ultrasonographic abnormalitie s seemed to have an influence on motility (P = 0.03), while no direct relat ionship was found with postural control, hand function or asymmetry. It is unclear whether this poor coordination of gross motor function will have co nsequences for appropriate visual-motor and sensorimotor integration therew ith hampering later cognitive function, as often described in preterm infan ts. It is suggested that the poor postural control found in many infants is the result of both myogenic and/or neurogenic deviations and associated wi th cerebral pathology, but is also caused by the preterm birth and its nurs ing consequences. (C) 2000 Elsevier Science Ireland Ltd. All rights reserve d.