Hand Function at 18-22 Months Is Associated with School-Age Manual Dexterity and Motor Performance in Children Born Extremely Preterm.

OBJECTIVES To determine associations between 18-22 month (early) hand function and scores on the Movement Assessment Battery for Children, 2nd edition (MABC) at 6-7 years of age (school-age) in extremely preterm children. STUDY DESIGN Prospective multi-center cohort of 313 extremely preterm children with early hand function assessment and school-age MABC testing. Early hand function was compared with 'definite deficits' (MABC <5th percentile) and MABC standard scores. Early hand function was categorized as 'no deficit' versus 'any deficit'. Mixed effect regression models evaluated the association of early hand function with MABC deficits, controlling for multiple demographic, neonatal, and childhood factors. RESULTS Children with early hand function deficits were more likely to have definite school-age deficits in all MABC subtests (Manual Dexterity, Aiming and Catching, and Balance) and to have received physical or occupational therapy (45% vs 26% P < .001). Children with early hand function deficits had lower Manual Dexterity (p=0.006), Balance (p=0.035) and Total Test scores (p=0.039). Controlling for confounders, children with early hand function deficits had higher odds of definite school-age deficits in Manual Dexterity (aOR (95% CI):2.78 (1.36, 5.68), p=0.005) and lower Manual Dexterity (p=0.031) and Balance (p=0.027) scores. When excluding children with cerebral palsy and intelligence quotients<70, hand function deficits remained significantly associated with manual dexterity. CONCLUSION Hand function deficits at 18-22 months are associated with manual dexterity deficits and motor difficulties at school-age, independent of perinatal-neonatal factors and the use of occupational or physical therapy. This has significant implications for school success, intervention and rehabilitative therapy development.