Gross motor development of Nigerian children.

A prospective study of 320 Nigerian children was undertaken to determine their pattern of motor development by recording the age at attainment of 12 gross-motor milestones. The children were all born full term and were neurologically normal at birth. They were recruited in the first week of life and seen at regular intervals in a well-baby clinic, where their parents were questioned about the ages at attainment of milestones. Results show that most gross-motor milestones were attained at earlier ages by these children than by children studied to establish norms for the traditional tests of motor development that have long been in use. Our findings confirm several previous reports which emphasize the more rapid attainment of motor milestones such as 'sit without support', 'crawl', 'stand well alone' and 'walk well alone' by black as compared with white children. But, conversely, a number of transitional milestones such as 'roll over', 'pull self to stand' and 'stand holding on' were achieved later by children in this study than by their non-African counterparts. Girls in this study were slightly advanced, relative to boys, in their attainment of most milestones. The results of this study have been incorporated into a chart which can be used in well-baby clinics to detect children with motor delay.     

Gross and fine motor development in 45,X and 47,XXX girls

Neuromuscular deficits have been described in 47,XXY and 47,XYY boys, but gross and fine motor development of girls with sex chromosome aneuploidy has not been extensively studied. Twenty-one propositae 8 to 19 years of age, identified through newborn screening to be 45,X, 47,XXX, or 45,X mosaic, and 11 control girls were evaluated by a physical therapist unaware of their genetic constitution. The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) was administered, and the quality of neuromuscular function was determined. The 45,X and 47,XXX propositae exhibited both gross and fine motor dysfunction, with 12 of 15 BOTMP composite scores below the 10th percentile. The clinical assessment confirmed the BOTMP findings, with 13 propositae exhibiting dysfunctional sensory-motor integration. A delay in the age of independent walking confirmed the consistency of motor developmental dysfunction throughout time. Sex chromosome mosaics were more similar to control girls. The gross and fine motor delays were frequently associated with a moderate to severe language dysfunction which adversely affected classroom performance. Regular developmental assessments of children with sex chromosome aneuploidy, including sensory-motor integration, should assist in the identification of early developmental delays and permit appropriate intervention.     

Gross and fine motor development in 47,XXY and 47,XYY males

Neuromuscular deficits described in early childhood as motor awkwardness or slow movements are still clinically present in school-aged boys with XXY and XYY sex chromosome aneuploidy. A control group of 14 boys (6 to 19 years of age) and 14 XXY and four XYY boys (6 to 15 years of age), identified by newborn screening, were blindly evaluated by a physical therapist. The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) was administered and a clinical rating of neurologic status and sensory-motor integration was assigned. On the motor proficiency test, the XXY boys had significantly lower mean scores for upper limb coordination, speed and dexterity, and on gross motor and battery composites. The neuromuscular status of the aneuploid boys was deficient, with hypotonia, apraxia, primitive reflex retention, and problems with bilateral coordination and visual-perceptual-motor integration. This mild to moderate dysfunctional sensory-motor integration, as well as previously described auditory-processing deficits and dyslexia, contributed to school performance below that expected from their cognitive potential.     

Thrombocytopenia related neonatal outcome in preterms

Objective To investigate the thrombocytopenia and platelet transfusion related outcome in very preterm infants. Methods Cases (n=94) with at least one episode of thrombocytopenia (platelet counts <150X10⁹/L) and controls (n=70) were identified from a database of 1054 neonates with gestational age ≤32 weeks admitted to a level III NICU. Thrombocytopenia and platelet transfusion related morbidity (IVH, sepsis, NEC, and bleeding) and mortality were analyzed with respect to gestational age (<28 weeks and 28–32 weeks), severity of thrombocytopenia (mild if platelet count ≥ 100 and <150X10⁹/L, moderate if count ≥ 50 and <100X10⁹/L, and severe if platelets <50X10⁹/L), age of thrombocytopenia onset (early <72 hours and late ≥72 hours). Results The majority of thrombocytopenia (67.0%) was diagnosed after 72 hours of age, and was mild in 12.8%, moderate in 36.2% and severe in 51.0% of the cases. Neonates with severe and moderate thrombocytopenia were more frequently born at lower gestational age and birth weight. NEC and sepsis especially that caused by Candida infection, were associated with severe thrombocytopenic events. The development of IVH was strongly associated with lower gestational age but not the severity and age of thrombocytopenia onset. Mucocutaneous bleeding complicated 18.4% of cases with severe and late-onset thrombocytopenia (7/38). Platelets were transfused to 85.4% of infants with severe and 64.7% of infants with moderate thrombocytopenia (P<0.02). The gestational age of the majority of the platelet transfused neonates (49/60, 81.7%) was <28 weeks. Mean gestational age and birth weight, and rates of severe thrombocytopenia, IVH, sepsis and mortality were comparable in transfused vs not-transfused infants with gestational age 28–32 weeks. Platelet transfused neonates with gestational age <28 weeks had lower birth weights, were more often severely thrombocytopenic, and died more frequently than infants of a similar gestational age who were not transfused. Conclusion Platelet transfusions did not lower mortality in very premature born infants with moderate and severe thrombocytopenia during the NICU admission.     

Gross motor development in full-term Greek infants assessed by the Alberta Infant Motor Scale: Reference values and socioeconomic impact

Objective

The aims of this study were to investigate gross motor development in Greek infants and establish AIMS percentile curves and to examine possible association of AIMS scores with socioeconomic parameters.

Methods

Mean AIMS scores of 1068 healthy Greek full-term infants were compared at monthly age level with the respective mean scores of the Canadian normative sample. In a subgroup of 345 study participants, parents provided, via interview, information about family socioeconomic status. Multiple linear regression analysis was performed to evaluate the relationship of infant motor development with socioeconomic parameters.

Results

Mean AIMS scores did not differ significantly between Greek and Canadian infants in any of the 19 monthly levels of age. In multiple linear regression analysis, the educational level of the mother and also whether the infant was being raised by grandparents/babysitter were significantly associated with gross motor development (p = 0.02 and p < 0.001, respectively), whereas there was no significant correlation of mean AIMS scores with gender, birth order, maternal age, paternal educational level and family monthly income.

Conclusions

Gross motor development of healthy Greek full-term infants, assessed by AIMS during the first 19 months of age, follows a similar course to that of the original Canadian sample. Specific socioeconomic factors are associated with the infants' motor development.     

Gross motor skills of premature, very low-birthweight Chinese children

We investigated whether premature, very low-birthweight (VLBW) Asian children without major handicap had poor motor skills compared with their normal birthweight counterparts. We compared a cohort of 42 preterm babies with birthweights <1500 g who participated in a developmental stimulation programme with 69 children of normal birthweight matched for age, gender and paternal education. VLBW children participated in the programme for 3 years and were followed to the age of 5-7 years. The VLBW cohort had significantly lower scores in B- and C-rated skills of the Peabody Developmental Motor Scales. Their total score was also significantly lower. This is in agreement with studies in other populations that found that VLBW children had lower motor scores and that early interventions failed to ameliorate this motor disadvantage.     

Gross motor milestones in preterm infants: correction for degree of prematurity

The age of gross motor milestone attainment and how it is affected by degree of prematurity at delivery were studied in 100 high-risk, preterm (less than 32 weeks) infants with normal motor outcome. We calculated the mean age of attainment for each milestone on the basis of chronologic age from the date of delivery and term age equivalent, correcting for degree of preterm delivery. Half of these preterm infants were male; 70% were black. The infants were compared with a population of normal infants born at term. In this very preterm population, there were no consistent sex differences, but black infants generally attained motor milestones before white infants. For each motor milestone, regardless of gender or race, the mean term age equivalents of attainment for very preterm infants closely approximated the mean ages of milestone attainment for term infants, whereas the mean chronologic ages were delayed 2 or 3 months. We conclude that very preterm infants can be expected to demonstrate sequential gross motor development at a rate expected for degree of prematurity. Chronologic age is not a valid measurement scale to use in determining motor delay in very preterm infants.