Cerebral Palsy and Motor Impairment After Extreme Prematurity: Prediction of Diagnoses at Ages 2 and 10 Years - 09/07/24

Doi : 10.1016/j.jpeds.2024.114037

Timothy Marinelli, DO ¹, Joe X. Yi, BS ², T.Michael O'Shea, MD, MPH ², Robert M. Joseph, Ph.D ³, Stephen R. Hooper, PhD ², Karl C.K. Kuban, MD ⁴, Christina Sakai, MD ⁵, Michael E. Msall, MD ⁶, Rebecca Fry, PhD ⁷, Rachana Singh, MD, MS ^1,^⁎
on behalf of
ELGAN-ECHO Study Investigators^{^†}
A complete list of non-author contributors appears in the Acknowledgments.
Julie V. Rollins, MA Site, Bhavesh Shah, MD, Linda Van Marter, MD, MPH, Camilla Martin, MD, MPH, Janice Ware, PhD, Caitlin Rollins, MD, Cynthia Cole, MD, Ellen Perrin, MD, Christina Sakai, MD, Frank Bednarek, MD (deceased), Richard Ehrenkranz, MD (deceased), Jennifer Benjamin, MD, Angela Montgomery, MD, T. Michael O'Shea, MD, MPH, Lisa Washburn, MD, Carl Bose, MD, Diane Warner, MD, MPH, Steve Engelke, MD, Amanda Higginson, MD, Jason Higginson, MD, Kelly Bear, MD, Mariel Poortenga, MD, Steve Pastyrnak, PhD, Padu Karna, MD, Nigel Paneth, MD, MPH, Madeleine Lenski, MSPH, Michael Schreiber, MD, Scott Hunter, PhD, Deborah Klein, BSN, RN, Maureen Pimental, BA, Collen Hallisey, BA, Taryn Coster, BA, Maddie Dolins, Maggie Mittleman, Hannah Haile, Julia Rohde, Kaysi Herrera Pujols, Ellen Nylen, RN, Emily Neger, MA, Kathryn Mattern, BA, Catherine Ma, Deanna Toner, Elizabeth Vitaro, Lauren Venuti, BA, Beth Powers, RN, Ann Foley, EdM, Taylor Merk, Joanne Williams, RN, Elaine Romano, APRN, Christine Henry, Debbie Hiatt, BSN (deceased), Nancy Peters, RN, Patricia Brown, RN, Emily Ansusinha, BA, Jazmyne James, MS, Nou Yang, MS, Gennie Bose, RN, Janice Wereszczak, MSN, Janice Bernhardt, MS, RN, Joan Adams, (deceased), Donna Wilson, BA, BSW, Nancy Darden-Saad, BS, RN, Bree Williams, Emily Jones, Hannah Morris, Dinah Sutton, RN, Julie Rathbun, BSW, BSN, Stephanie Fagerman, William Boshoven, Jalen Johnson, Brandon James, Cynthia Gile, BS, CCRC, Karen Miras, RN, BSN, Carolyn Solomon, RN, Deborah Weiland, MSN, Rugile Ramoskaite, BA, Suzanne Wiggins, MA, Krissy Washington, MA, Ryan Martin, MA, Barbara Prendergast, BSN, RN, Emma Lynch, MPH, Sabina Hajdarovic, Beth Kring, RN, Anne Smith, PhD, Susan McQuiston, PhD, Samantha Butler, PhD, Rachel Wilson, PhD, Kirsten McGhee, PhD, Patricia Lee, PhD, Aimee Asgarian, PhD, Anjali Sadhwani, PhD, Brandi Henson, PsyD, Cecelia Keller, PT, MHA, Jenifer Walkowiak, PhD, Susan Barron, PhD, Alice Miller, PT, MS, Brian Dessureau, PhD, Molly Wood, PhD, Jill Damon-Minow, PhD, Elaine Romano, MSN, Linda Mayes, PhD, Kathy Tsatsanis, PhD, Katarzyna Chawarska, PhD, Sophy Kim, PhD, Susan Dieterich, PhD, Karen Bearrs, PhD, Ellen Waldrep, MA, Jackie Friedman, PhD, Gail Hounshell, PhD, Debbie Allred, PhD, Rebecca Helms, PhD, Lynn Whitley, PhD, Gary Stainback, PhD, Lisa Bostic, OTR/L, Amanda Jacobson, PT, Joni McKeeman, PhD, Echo Meyer, PhD, Steve Pastyrnak, PhD, Joan Price, EdS; Megan Lloyd, MA, EdS, Susan Plesha-Troyke, OT, Megan Scott, PhD, Katherine M. Solomon, PhD, Kara Brooklier, PhD, Kelly Vogt, PhD

¹ Department of Pediatrics, Tufts University School of Medicine, Boston, MA
² Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC
³ Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA
⁴ Department of Pediatrics and Neurology, Boston Medical Center, Boston, MA
⁵ Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
⁶ Department of Pediatrics, Kennedy Research Center and Comer Children's Hospital, The University of Chicago Pritzker School of Medicine, Chicago, IL
⁷ Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC

^∗Reprint requests: Rachana Singh, MD, Department of Pediatrics, Tufts University School of Medicine, 800 Washington St, Boston, MA 02111Department of PediatricsTufts University School of Medicine800 Washington StBostonMA02111

Abstract

Objective

To identify perinatal factors in children born extremely preterm (EP) that were associated with motor impairment (MI) at 2 and 10 years of age and develop a predictive algorithm to estimate the risk of MI during childhood.

Study design

Participants of the Extremely Low Gestational Age Newborns Study (ELGANS) were classified as: no MI, MI only at 2 years, MI only at 10 years, and MI at both 2 and 10 years, based on a standardized neurological examination at 2 and the Gross Motor Function Classification System (GMFCS) at 10 years of age. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to develop the final predictive model.

Results

Of the 849 study participants, 64 (7.5%) had a diagnosis of MI at both 2 and 10 years and 63 (7.4%) had a diagnosis of MI at 1 visit but not the other. Of 22 total risk factors queried, 4 variables most reliably and accurately predicted MI: gestational age, weight z-score growth trajectory during neonatal intensive care unit (NICU) stay, ventriculomegaly, and cerebral echolucency on head ultrasound. By selecting probability thresholds of 3.5% and 7.0% at ages 2 and 10, respectively, likelihood of developing MI can be predicted with a sensitivity and specificity of 71.2%/72.1% at age 2 and 70.7%/70.7% at age 10.

Conclusion

In our cohort, the diagnosis of MI at 2 years did not always predict a diagnosis of MI at 10 years. Specific risk factors are predictive of MI and can estimate an individual infant's risk at NICU discharge of MI at age 10 years.

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Keywords : cerebral palsy, extremely preterm, extremely low gestational age newborns, gross motor function classification system, motor impairment

Abbreviation : CP, EI, ELGAN, EP, GMFCS, LASSO, MI

Plan

Methods

Variables Considered for Predictive Model

Statistical Analysis

Results

MI at Age 2 years Only

MI at Age 10 years Only

MI at Age 2 and MI at Age 10 Years

Predictive Modelling

Discussion

Ethical Consideration

CRediT authorship contribution statement

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Cerebral Palsy and Motor Impairment After Extreme Prematurity: Prediction of Diagnoses at Ages 2 and 10 Years - 09/07/24

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