Motor Outcomes in Premature Infants

Maureen Connors Lenke, BS, OTR/L

Disclosures

NAINR. 2003;3(3) 

In This Article

Neurological Basis of Motor Deficits in Preterm Infants

Premature infants are highly susceptible to brain injury because of difficulty with blood flow regulation and the disruption of blood flow and/or oxygen delivery to the brain. The preterm infant is born during a critical period of rapid fetal brain growth and maturation. Thus, the preterm brain is much more susceptible to injury than the full-term infant brain. The brain tissue most prone to injury in the preterm infant is the fragile periventricular area. The larger the area of periventricular injury, the greater the impact will be on subsequent motor function.[4]

Periventricular leukomalacia (PVL) is a specific condition referring to cell death of the white matter surrounding the lateral ventricles.[4] PVL is caused by a combination of decreased blood flow to the brain and decreased oxygen in the blood. PVL is strongly correlated with motor impairments, especially impacting the lower extremities.[4]

Intraventricular hemorrhage (IVH), or bleeding into the ventricles, is also highly associated with motor impairment.[4] The incidence of IVH has been reported to range from 15% to 40%, depending on gestational age.[5] The risk of IVH is highest in the immediate perinatal period, with most bleeds occurring in the first 3 to 4 days after birth. The incidence and severity of IVH are related to the degree of prematurity, with the smallest (especially those weighing less than 1,250 grams) and those born at less than 30 weeks' gestation being at highest risk for IVH.[5] The presence of PVL or IVH greatly increases the probability of an infant developing CP.[5]

It is not uncommon for premature infants to develop motor deficits without an apparent brain injury. Even in infants with the diagnosis of IVH or PVL, the degree of impairment, if any, cannot be accurately predicted. Although these children are at a higher risk, even a precise description of injury does not allow a precise prediction regarding recovery or motor outcome.

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