title: Predicting severe motor impairment in preterm children at age 5 years.
abstract: OBJECTIVE
  To determine whether the ability to predict severe motor impairment at age 5 years improves between birth and 18 months.
  
  
  METHODS
  Ancillary study of the Caffeine for Apnea of Prematurity Trial.
  
  
  METHODS
  International cohort of very low birth weight children who were assessed sequentially from birth to 5 years.
  
  
  METHODS
  Severe motor impairment was defined as a score <5th percentile on the Movement Assessment Battery of Children (MABC), or inability to complete the MABC because of cerebral palsy. Multivariable logistic regression cumulative risk models used four sets of predictor variables: early neonatal risk factors, risk factors at 36 weeks' postmenstrual age, risk factors at a corrected age of 18 months, and sociodemographic variables. A receiver operating characteristic curve (ROC) was generated for each model, and the four ROC curves were compared to determine if the addition of the new set of predictors significantly increased the area under the curve (AUC).
  
  
  RESULTS
  Of 1469 children, 291 (19.8%) had a severe motor impairment at 5 years. The AUC increased from 0.650 soon after birth, to 0.718 (p<0.001) at 36 weeks' postmenstrual age, and to 0.797 at 18 months (p<0.001). Sociodemographic variables did not significantly improve the AUC (AUC=0.806; p=0.07).
  
  
  CONCLUSIONS
  Prediction of severe motor impairment at 5 years of age using a cumulative risk model improves significantly from birth to 18 months of age in children with birth weights between 500 g and 1250 g.
  
  
  BACKGROUND
  ClinicalTrials.gov number NCT00182312.
authors.affiliation: Department of Pediatrics, University of British Columbia, and Child and Family Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Synnes
authors.affiliation: Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia Departments of Obstetrics and Gynaecology and Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Anderson
authors.affiliation: Department of Pediatrics, University of British Columbia, and Child and Family Research Institute, Vancouver, British Columbia, Canada.
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Grunau
authors.affiliation: Alberta Children's Hospital Research Institute for Child and Maternal Health and Departments of Pediatrics and Community Health Services, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Dewey
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Moddemann
authors.affiliation: Department of Paediatrics, James Cook University Hospital, Middlesbrough, UK.
authors.forename: Win
authors.initials: W
authors.lastname: Tin
authors.affiliation: Departments of Obstetrics and Gynaecology and Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Davis
authors.affiliation: Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia Departments of Obstetrics and Gynaecology and Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Lex W
authors.initials: LW
authors.lastname: Doyle
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Foster
authors.affiliation: McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: May
authors.initials: M
authors.lastname: Khairy
authors.affiliation: Windsor Regional Hospital, Windsor, Ontario, Canada.
authors.forename: Chukwuma
authors.initials: C
authors.lastname: Nwaesei
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Division of Neonatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schmidt
mesh_terms: D000367:Age Factors; D001724:Birth Weight; D002547:Cerebral Palsy / Q000209:etiology; D002658:Developmental Disabilities / Q000209:etiology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D009069:Movement Disorders / Q000209:etiology*; D012372:ROC Curve; D012307:Risk Factors
keywords: Neonatology; Neurodevelopment; Outcomes research