J. Pediatr. (Rio J.) vol.93 número4

(1)

JPediatr(RioJ).2017;93(4):328---342

www.jped.com.br

REVIEW

ARTICLE

Motor

development

of

preterm

infants

assessed

by

the

Alberta

Infant

Motor

Scale:

systematic

review

article

夽

Rubia

do

N. Fuentefria,

Rita

C. Silveira,

Renato

S. Procianoy

∗

UniversidadeFederaldoRioGrandedoSul(UFRGS),ProgramadePós-Graduac¸ãoemSaúdedaCrianc¸aedoAdolescente,Porto

Alegre,RS,Brazil

Received17October2016;accepted22March2017 Availableonline12May2017

KEYWORDS

Prematurity; Childdevelopment; Motordevelopment

Abstract

Objective: Prematurenewbornsareconsideredatriskformotordevelopmentdeficits,leading totheneedformonitoringinearlylife.Theaimofthisstudywastosystematicallyreviewthe literatureaboutgrossmotordevelopmentofpreterminfants,assessedbytheAlbertaInfant MotorScale(AIMS)toidentifythemainoutcomesindevelopment.

Datasource: Systematicreviewofstudiespublishedfrom2006to2015,indexedinPubmed, Scielo,Lilacs,andMedlinedatabasesinEnglishandPortuguese.Thesearchstrategyincluded thekeywords:AlbertaInfantMotorScale,prematurity,preterm,motordevelopment,postural control,andfollow-up.

Datasummary: Atotalof101articleswereidentifiedand23wereselected,accordingtothe inclusioncriteria.Theagesofthechildrenassessedinthestudiesvaried,includingthefirst6 monthsupto15or18monthsofcorrectedage.Thepercentagevariationinmotordelaywas identifiedinthemotoroutcomedescriptionsoftenstudies,rangingfrom4%to53%,depending ontheagewhentheinfantwasassessed.Thestudiesshowsignificantdifferencesinthemotor developmentofpretermandfull-terminfants,withadescriptionoflowergrossscoresinthe AIMSresultsofpreterminfants.

Conclusions: Itisessentialthatthefollow-upservicesofat-riskinfantshaveassessment strate-giesandmonitoringofgrossmotordevelopmentofpreterminfants;AIMSisanassessmenttool indicatedtoidentifyatypicalmotordevelopmentinthispopulation.

夽

Pleasecitethisarticleas:FuentefriaRN,SilveiraRC,ProcianoyRS.MotordevelopmentofpreterminfantsassessedbytheAlbertaInfant MotorScale:systematicreviewarticle.JPediatr(RioJ).2017;93:328---42.

∗_{Corresponding}_author.

E-mail:rprocianoy@gmail.com(R.S.Procianoy). http://dx.doi.org/10.1016/j.jped.2017.03.003

(2)

Motordevelopmentofpreterminfants 329

PALAVRAS-CHAVE

Prematuridade; Desenvolvimento infantil;

Desenvolvimento motor

DesenvolvimentomotordeprematurosavaliadospelaAlbertaInfantMotorScale: artigoderevisãosistemática

Resumo

Objetivo: Recém-nascidosprematurossãoconsiderados deriscopara déficitsno desenvolvi-mentomotor,ocasionandoanecessidadedeacompanhamentonosprimeirosanosdevida.O objetivodopresenteestudoérevisardeformasistemáticaaspublicac¸õesqueabordamo desen-volvimentomotoramplodecrianc¸asnascidasprematuras,avaliadaspormeiodaAlbertaInfant MotorScale(AIMS),demodoàapontarosprincipaisdesfechosmotores.

Fontesdosdados: Revisãosistemáticadaspublicac¸õesdoperíodode2006a2015,indexadas nasbasesdedadosPubmed,Scielo,LilacseMedline,nosidiomasinglêseportuguês.A estraté-giadebuscaincluiupalavras-chaves:prematuro,pré-termo,prematuridade,desenvolvimento motor, controle postural, seguimento, Alberta Infant Motor Scale, prematurity, pre-term, motordevelopment,posturalcontrolandfollow-up.

Síntesedosdados: Foramidentificados101 artigoseselecionados23,conforme critériosde inclusão.Asidadesdascriançasavaliadasnosestudosincluíramosprimeiros6mesesatéos 15 ou 18 mesesde idade corrigida.Variado percentual de atraso motor foi identificado na descriçãodosdesfechosmotoresde10estudos,indode4a53%,dependendodaidadeemque obebêfoiavaliado.Osestudosapontamdiferençassignificativasnodesenvolvimentomotor deprematurosecriançasnascidasatermo,comdescriçãodeescoresbrutosmaisbaixosnos resultadosdaAIMSdecriançasprematuras.

Conclusões: Éfundamentalqueosserviçosdefollow-updebebêsderiscoapresentem estraté-giasdeavaliaçãoeacompanhamentododesenvolvimentomotoramplodeprematuros,sendoa AIMSumaferramentadeavaliaçãoindicadaparaidentificarcomportamentosmotoresatípicos nessapopulação.

eumartigoOpenAccesssobumalicenc¸aCCBY-NC-ND(http://creativecommons.org/licenses/ by-nc-nd/4.0/).

Introduction

Advances in clinical management, including the use of pediatricmechanicalventilators,surfactants,andprenatal corticosteroids, are factors that have greatly contributed toimprovesurvivalofpretermandat-riskbabiesinrecent decades.1 _Although _the _mortality _rate _has _dramatically improvedoverthepastdecades,pretermnewbornsremain vulnerable to many complications, including neurological insult and long-term growth and development deficits,2 resultinginthenecessityforamuchstrictermonitoringthan inthepast.3

As birth weight and gestational age decrease, and in cases where thereis an association of adverse biological conditions, such as grade III and IV peri-intraventricular hemorrhage, periventricular leukomalacia, prolonged mechanicalventilation,stageIIIretinopathyofprematurity or bronchopulmonary dysplasia, the risk of neurodevel-opmental abnormalities increases.4 _{Particularly,} _infants bornatlessthan32weeksofgestationalageandweighing less than 1500g have a high biological risk condition for development.5

Although transient neurological abnormalities occur in 40---80% of cases, disappearing in the second year of life, severeanddefinitiveneurosensorysequelae,suchasvisual and auditory deficiency and cerebral palsy, are detected in4---20% of extremelylow-weightpreterminfants.5---7 Sig-nificant developmental delays are also evident in 16% of thecases,7_{demonstrating}_a_significant_correlation_between developmentaldelayandpretermbirth.8

Inthis sense,carryingoutperiodicevaluationsof each child’smotordevelopment(MD)progressisessentialforthe identificationof deficits,thusfacilitating referraltoearly interventionprograms.3,8 _Although _there_is _no homogene-ity amongthe several studies regarding the best method forevaluatingdevelopment,theimportanceofearly iden-tification, i.e., within the child’s first year of life, is a consensus.5,9 _Among_the_assessment _tools_used_to_monitor alterationsinMDanddifferentiateatypicalmotorbehaviors, theAlbertaInfantMotorScale(AIMS)ishighlightedasavalid and reliable tool for evaluating at-risk infants,10 demon-strating unique characteristics regarding preterm infants’ qualityofmovement at anearly age.11,12 _In _contrast_with thetraditionalneurologicalexamination,thescale empha-sizesfunctionalcapacitiesandthequalityofmovement,13 offeringup-to-datenormativereferencevalues.14_AIMS_was validatedfortheBrazilianpediatricpopulation,resultingin aBrazilian Portuguese version,15 _and _new _standards_were establishedtobestrepresentthis.16 _It_has_high_sensitivity, specificity,andaccuracytodetectmotordeficits,being indi-catedinthefollow-upofpretermchildren’sMDinthefirst 18monthsoflife.17

(3)

330 FuentefriaRNetal.

mainmotoroutcomesinrelationtochildrenbornatterm, aged0---18monthsofcorrectedage(CoA).

Method

Sourceofdata

Asystematicreviewofarticlespublishedinthelast10years andavailableinthefollowingdatabases:USNationalLibrary ofMedicineNational Institutes ofHealth(PubMed), Scien-tificElectronicLibraryOnline(SciELO),LatinAmericanand Caribbean Health Sciences (LILACS), and National Library ofMedicine UnitedStates(MEDLINE) wascarriedout.The searchstrategyincluded thecombination of thefollowing keywordsinPortuguese:prematuro,pré-termo, prematuri-dade, desenvolvimento motor amplo, controle postural, seguimento.ItalsoincludedthefollowingwordsinEnglish: preterm, prematurity, gross motor development,postural control,Alberta Infant MotorScale, follow-up. The words werealwayscombinedusingthetermAND.Asimilarsearch wasperformedinalldatabases.Thekeywordswereselected basedonthesearchforDecs/MeSHterms(LILACSand Sci-ELO).

Selectioncriteria

Studieswereincluded when theymetthefollowing crite-ria: (1) Original articlesinvolving the observational study ofMDofpreterm infants,aged0---18monthsof CoA, pub-lishedinthelasttenyears(January01,2006toDecember 31,2015).TheCoArepresentstheadjustmentofthe chrono-logicalageaccordingtothedegreeofprematurity,thatis, theweeksthatwerelackingforthegestationalagetoreach 40weeksaresubtractedfromthepreterminfant’s chrono-logicalage.6₍₂₎_Studies_with_one_of_the_following_designs: cohortstudy(prospectiveorretrospective),cross-sectional study,control---casestudy;(3) studiesthat usedAIMSasa toolforassessingmotordevelopment;(4)studiespublished onlyinPortugueseorEnglish.

Inthepresentstudy,prematuritywasdefinedaccording tothe Shapiro---Mendoza andLackritz classification18_: _late prematurity(34weekscompleted to36weeksand6 days ofgestationalage),moderateprematurity(32weeksto33 weeksand6daysofgestationalage),andextreme prema-turity(23:31weeksand6daysofgestationalage).

Allstudiesthatmettheinclusioncriteriaweresubmitted todataextractionandcriticalevaluationprocess.Themain characteristics were summarized following a data extrac-tionmodelconsistingof:author/local;method,andsample; gestationalage and age at theevaluations; main results; associatedriskfactors;andstrengthsandlimitations.

Datasynthesis/analysis

Thesearchstrategyresultedinatotalof101listedtitles, ofwhich23wereselectedforthereview.Afterreadingthe titleandtheabstract,78articleswereexcluded,basedon theinclusioncriteria.The23selectedarticleswereincluded inthereviewandtheresultsweredescriptivelyanalyzed.

Results

and

discussion

ThecharacteristicsofthestudiesaredescribedinTable1. Itcanbeobservedthattheperiodof2010---2015hadthe highest numberofpublications onthe subject,exceptfor theyear2014, inwhichnoarticlewaspublishedwiththis approach.Intheanalysisofstudylocations,Brazilwasthe mostprevalent,with12publications.TheNetherlandsand Australiacameinsecondplace,withsevenstudies.

Itcanbeobservedthatchildren’sagesvariedinthe stud-ies.Ofthe23selectedarticles,sixaddressedtheevaluation ofMDinagegroupsinvolvingthefirst6monthsto15or18 months,whereasfourinvolvedthefirst6monthsupto12 or13monthsofCoA.Asinglestudyaddressedtheanalysis after12monthsofCoAupto18months.Onlytwoarticles includedthelong-termstudyofMD,withafollow-upuntil theageof4years,applyinganappropriatescaleforthisage group.Conversely,thelackoffollow-upinchildrenafter12 months of CoA wasobserved in some studies.19---22 _One _of theminvolvedevaluationsat3monthsofCoA;fourincluded evaluationsupto5or6months,andfiveuntil8or9months ofCoA.11,19---22

Regardingthe gestationalagesinvolved in the studies, itwasobservedthatalmosthalfofthepublications(n=11) comprisedasampleofpreterminfants,bothmoderateand extreme,ofwhicheightwereofextremeprematureinfants only.Conversely,ninestudiesincludedheterogeneous sam-plesregardingtheclassificationofprematurity, sincethey involvedthethreetypesinthesamesample(late, moder-ate,andextreme).21,23---25_One_study_did_not_clarify_the_GA rangeoftheevaluatedchildren.15

As for the designs, it was observed that most studies hadaprospectivecohort,totaling14articles;followedby thecross-sectionaldesign,witheightpublications.Mostof theanalyzedstudies(n=15)hadasampleconsistingonlyof preterminfants,anddidnotincludeacontrolgroup com-prisinginfantsbornatterm.Forcomparativepurposes,five of thesestudies usedtheAIMSnormative sample to iden-tify differences in the gross motor development between the groups.10,13,23,26,27 _The _normative _data _are _based_on _a populationof2200infantsbornatterm,aged0---18months, from Alberta, Canada.28 _Recently, _the _original _AIMS _data, collected20yearsago,werecomparedtodatafroma con-temporary sample of 650 Canadian children. The current normativevaluesremainappropriatetointerpretthetotal AIMSscore,andtheoriginalpercentilescontinuetoreflect the contemporaryorderand ageat onsetof infant motor skillsrepresentedintheAIMS.14

Therefore,AIMSnormativedatahavebeen widelyused nationallyandinternationallyasameasureofclinical out-come andresearch,10,12,13,17,21,29 _although_there_is _concern thatAIMSCanadianstandardswouldbeinadequatefor chil-drenofdifferentcultures.29,30_In_this_sense,_the_authors_of thenormativevaluereassessmentstudyaffirmedthat,given the stability of the resultsover a 20-year periodand the increase inthe ethnicdiversityof thecontemporary sam-ple, it may not be necessary to investigate international differences.14

(4)

Motor

development

of

preterm

infants

331

Table1 Characteristicsofstudiesinvolvingthemotordevelopmentofat-riskpreterminfantsassessedbytheAIMS.

Author/place Methodsand sample(n)

GAandageat evaluations

Mainresults Associatedriskfactors Strengthsandlimitations

Pinetal.

(2009)11_/Australia

--- Longitudinal --- 62PTand53 full-term

--- GA≤29w

--- 4---8mofCoA

--- At4m:PTscoredlowerinall subscalescoresandinthetotal score

--- At8m:PTscoredlowerin thesubscalesscoresofsitting andstandingandtotalscore

--- Nodescription --- PTwithGA≤29whaddifferentMD comparedtofull-termpeersat4and 8m;withmotorskillsthatprogress inadifferentiatedway

--- Motordelayinmorevertical positions(sittingandstanding)at8m ofCoA

--- Limitationsonthegeneralizationof results;andonthelackofpotential confounders

Prinsetal.(2010)36_/The Netherlands

--- Longitudinal

--- 70PT

--- IGA32<34w

--- 3,6,and9mof CoAand4years

--- At3m:12%hadmotordelay (n=8)

--- At9m:32%hadmotordelay (n=20)

--- At4years:17%hadmotor delay(n=12)

--- NoassociationofMDwith GA,BW,Apgarscore,and gender

--- AIMSresultsinthefirstyearoflife ofmoderatepreterminfantswere notpredictiveofoutcomesinMDat4 yearsofage

--- Limitationsregardinglossesto follow-up;researcherswerenot blindedtoGA;smallsamplesize

vanHaastertetal. (2006)13_/The Netherlands

---Cross-sectional, prospective

---800PT

---GA≤32w

---1,6,12,15,and 18mofCoA

---ThemeanscoresofthePT weresignificantlylowerthan thosebornatterm,atallage levels

---Motordelaywas associatedwith:BW (<1250g)at6---7mand 15---16m;genderat7---8m andnumberoffetusesat 5---6m

---ExistenceofaPT-specificMD trajectoryreflectingatypicalMD variant

---Thestudyshowsapercentage curveforPT,indicatingacutoffpoint formotorinterventionat4and8m: percentile<25

(5)

332

Fuentefria

RN

et

al.

Table1 (Continued)

Pinetal.

(2010)12_/Australia

---Longitudinal

---58PTand52 full-term

---GA≤29w

---4,8,12and18 mofCoA

---TotalscoresofPTwerelower inall4agegroups

---Anevidentdifferencewas foundinthesubscalesittingat 8mofCA

---PoorMDwasassociated with:HIV,chroniclung disease,pre-andpostnatal corticoid,andApgarscore (incertainagegroups)

---Childrenborn≤29wGAhada differentmotortrajectoryfromtheir full-termpeersfrom4to18mof CoA;withmotorskillsthatprogress differentlyovertime

---Duetothesmallsamplesizeofthe study,itwasnotpossibletoanalyze allfactorsassociatedwithMD; Limitationsonthegeneralizationof results

FormigaandLinhares (2011)10_/Brazil

---Cross-sectional

---308PT

---GA<37wand BW<2500g

---1at12m(12 independent groups)

---TheMDofBrazilianPTswas lowerthanthatoftheAIMS normativesampleinallage groupsevaluated(1---12m)

---Nodescription ---Thestudydemonstratesthatthe MDofPTisdifferentfromtheir full-termpeers

---ItfeaturesanMDcurveforBrazilian PT,accordingtothedistributionof AIMSpercentiles;indicatingthe5th and10thpercentilesasthebest cutoffstoidentifymotordelay

---Limitationsregardingthestudy designandthesample(itwasnot constantduringtheanalyzedm) ManaceroandNunes

(2008)32_/Brazil

---Cross-sectional

---44PT

---GA32<34w (samplestratified accordingtoBW)

---40thwof gestationalage,at 4and8mofCoA

---Thepercentilesvariedin bothgroupsbetween10%and 90%;withMDconsidered normalandsimilaracquisition rateinbothgroups

---Meansofthegroup≤1750g:

40thw:43.2%;4thm:42.9%; 8thm43.9%

---Meansofthegroup≥1750g:

40thw:47%;4thm47.8%;8th m:45.7%

---AIMSscoresdidnotshow associationwithBW

---ThePTshowedanormal progressivesequenceofmotorskill onset,withinanappropriatemean percentileintheAIMS(43.2---45.7%), independentlyfromBW

---Limitationsrelatedtogroup stratification,withaBW

(6)

Motor

development

of

preterm

infants

333

Wangetal. (2010)23_/Taiwan

--- Retrospective

--- 93PTwith BW<1501g

--- GA24<35w

--- 6and12mof CoA

---At6m:30.1%(n=28)had motordelay

---At12m:16.1%(n=15)had motordelay

--- At6and12mofCoAthePT showeddifferencesinthe meanscoreofAIMS,showing poorMDwhencomparedtothe normativedata

---At6m:Correlationof motordelaywithmedical complications,BW, maternallevelofschooling andApgarscoreinthe5th min

---At12m:Correlationwith medicalcomplicationsand maternalage

--- Thestudysubstantiatesand reinforcestheimportanceofearly assessmentatfollow-upinthefirst6 mofCoAofhigh-riskPT

--- Givesevidencethattheinfluence ofsocialandenvironmentalfactors onMDofPTissignificant

--- Thesamplesizewasrelatively small,withonly93casesfornine independentvariables;thestudy designwasretrospectiveandall variableswereextractedfroma conveniencecohortsample RestiffeandGherpelli

(2012)24_/Brazil

--- Prospective

--- 101PTand52 full-term

--- GA25<36w

--- 1---18mofCoA (monthly evaluations)

--- Therewasnodifference betweenPTandfull-term newbornsinthemeanAIMS scores,exceptfortheeighth, ninthandtenthm

---Themeanageat

independentgaitacquisitionin PTnewbornswas381.6days, andinfull-term,368.6days

--- Variablesassociatedwith delayedgaitacquisition: BW,birthlength,and durationofneonatal hospitalization

---Thestudypresentsevidencethat prematureinfantsacquire

independentgaitlaterthanfull-term infants,withadelayof

approximatelyonemonth

---Thevariablesbirthweightand lengthanddurationofneonatal hospitalizationwerepredictiveof delayedgaitacquisitioninPT Spittleetal.

(2015)17_/Australia

--- Cohort, prospective

--- 138PT

--- GA<30w

--- 4,8and12mof CoAandat4years

---At4m:22%(n=19)had percentile<10th

---At8m:

26%(n=23)hadpercentile <5th;

---At12m:36%(n=31)had percentile<5th

Cerebralpalsy(4years):7%

(n=6)hadCP

--- Nodescription ---AIMSaccuracywasbetterwhenthe threeassessmentsovertimeshowed delay,ratherthanonlyone.AIMS showedtobelessaccurateat12m andmoreaccurateat4mformotor deficitsfoundat4years,includingCP ---Thestrengthsincludetheuseof standardizedmotorassessmentsfora longtimeandthehighfollow-up rates

(7)

334

Fuentefria

RN

et

al.

RestiffeandGherpelli (2006)26_/Brazil

---Cohort, observationaland prospective

---43PT

---IG26<36w

---0---13mofCoA (monthly evaluations)

---ThemeangrossMDscoresof thePTweredifferentfrom thoseoftheAIMSstandard, onlywhenusingchronological age.Whencorrectingforage, thescoresweresimilar ---AllPTwereabletowalk withouthelpbefore18mof CoA

---Nodescription ---Theresultssuggestthat,tomore accuratelyidentifychildrenwithreal motordelaybyAIMS,the

chronologicalageshouldbe

correctedaccordingtothedegreeof prematurity,preventingfalse negatives

ValentiniandSaccani (2012)15_/Brazil

---Cross-sectional andlongitudinal

---766childrenand 22professionals

---0---18m ---ThePTshoweddifferencesin relationtothefull-term childrenregardingthegross andpercentilescores;PT scoreswerethelowest

---Theresultsofpremature infantswereassociatedwith atypicalMDoratrisksituation (theageusedwasnot corrected)

---Nodescription ---Thefinaltranslationandtheedited scaleresultedinthe

Brazilian---PortugueseversionofAIMS (AIMS-BR);avalidatedandreliable tooltoassesschilddevelopmentand plananinterventionforBrazilian children.

---Limitedpredictivevaliditywas observed,whichmaybeduetothe shorttimeduringwhichthegroups werefollowedlongitudinally FettersandHuang

(2007)19_/Boston,_USA

---Cohort

---68children(30 PTwithVLBWand withwhitematter lesions;21PTwith VLBWandno whitematter lesions;17 full-terminfants)

---GA24<31wand 6days

---1,5and9mof CoA

---Therewerenodifferencesin thescoresofthesubscales,the totalscoreandtheAIMS percentilebetweenPTwithout lesionsandfull-termbabies,at 1and5m

---At9m,therewasa differenceinthetotalscore andtheAIMSpercentile betweenPTwithandwithout whitematterlesion

---ThegroupofPTwithwhite matterlesionhadthelowest scoresatAIMS

---AIMSscoreswerenot associatedwith:gender, ethnicity,GA,orBW

---Thepronesleeping positionwaspositively associatedwithMD

---At5m,playinginthe pronepositionhadpositive effectsonMD

---Thedatasuggestthatsleepingin thesupinepositiondoesnotappear tohaveanegativeeffectonMD;the pronepositionappearstohavea positiveimpact

---At5m,sleepingandplayinginthe pronepositionweresignificantly associatedwithAIMSscores

(8)

Motor

development

of

preterm

infants

335

Formigaetal. (2010)31_/Brazil

--- Prospective

--- 10children

--- PTwithLBW (meanGA:32.8w)

--- 4---8mofCoA

---From4to5m:50%with suspectedMD;40%withmotor delay

--- Themeanscoreinthesitting positionincreasedoverthe threeassessments;thesetting positionshowedahigh correlationwiththeother acquisitions

--- Nodescription --- AIMSalloweddetectingMDdelayin PTchildrenbornwithlowweightup tothe8thmofCoA,mainlyregarding sittingcapacity

--- Therewasagreatercorrelation betweenthesittingandtheprone positionateachageevaluated

--- Limitationsregardingsamplesize andabsenceofcontrolgroup

Cabraletal. (2014)20_/Brazil

--- Cross-sectional andcomparative study

---30children(15 PTand15 full-term)

GA:PT<37w

--- 4---6mofCoA

--- 53%(n=8)ofPThad percentileequaltoorlower than5atAIMS

---Therewasnodifferencein AIMStotalscore,thegroups weresimilarintermsofMD

--- Nodescription ---HighMDvariabilityobservedamong thesubjects,sincebothgroupshad childrenwithhighandlowmotor performance

---Thesamplesizelimitedanalysesof correlationbetweenimportantstudy variables

Wangetal. (2013)33_/Taiwan

--- Longitudinal

--- 35PTwithPVL; 70PTwithout PVL;76full-term infants

--- GA≤27w

--- 6,12,and18m ofCoA

--- Differenceswerefoundin totalscoresbetweenPT withoutPVLandfull-term infantsonlyat6and12m;and nodifferencewasfoundat18 m

--- At6,12,and18m, differenceswerefoundinthe totalscoresbetween:PTwith PVLvs.PTwithoutPVL; PTwithPVLvs.full-term infants

---At18m,onlyPTwithPVL weredifferentfromPTwithout PVLandoffull-terminfants

---Nodescription ---FirststudythatshowsMDresults throughtheAIMSofVLBWPTwith PVL

---VLBWPTwithcysticPVLareat greaterriskofmotorimpairmentand delaysinthegrossmotormilestones whencomparedtoPTwithoutPVL, withthesupinesubscalebeingthe mostusefultodiscriminatethem,as earlyas6mofCoA

(9)

336

Fuentefria

RN

et

al.

Nuysinketal. (2013)27_/The Netherlands

---Prospective cohort

---95PT

---GA<30wor BW<1000g

---3,6,and15m ofCoA

---Themeanageofgait acquisitionwas15.7mofCoA (50%ofthesamplewalkedat thisage)

---Childrenbornwithlessthan 30wofGAstartedwalking independentlyapproximately3 maftertheirfull-termpeers, evenwithagecorrection

---Thelevelofgrossmotor maturationat6mofCA, andethnicitywereclearly associatedwithageat independentgait acquisition

---AIMSat3mofCoAcouldnot reliablypredictthegrossMDor walkingskillsat15mofvery prematurebabies

---Aclinicalimplicationisthatthe CoAof3mcanbeconsidered precocioustogivepredictivevalidity ontheoutcomesinthelaterMDof preterminfants

---Limitationsrelatedtosamplesize andthepossibilityofmemoryand selectionbiasinthemeanagesofthe evaluations

Burgeretal.

(2011)25_/South_Africa

---Descriptiveand prospective

---115children withBW≤1250g

---GA:27<36w

---3and12mof CoA

---22children(19%)hada percentilebelow5at12mof CoA

---Themeanpercentileof evaluationsat12mofCoAwas 35.0±25.1

---Nodescription ---AIMSat12m,wasusedinthe child’sfollow-up,evaluatedusingthe Prechtlmethodat3m,whichshowed highpredictivevalidity,sensitivity andspecificity

---Highspecificityandlowfalse positiveresultsdonotadd

unnecessaryreferralofinfantstothe alreadyoverburdenedand

underdevelopedrehabilitation services

Snideretal.

(2008)22_/Netherlands

---Prospective cohort

---100children

---GA≤32wand BW<1500g

---34w;atterm (38---40w)andat3 mofCoA

---37%ofthechildren(n=37) hadabnormaldevelopmentat 3mofCoA(percentile<10)

---Themeanpercentileat3m ofCoAwas17.1(11.7),ranging from2to55

---Nodescription ---AIMSwasusedinthefollow-up evaluationat3mofCoA

---Alowpowerratio(r≤0.25)was foundbetweengeneralmovements assessmentandthetestsusedat3m

(10)

Motor

development

of

preterm

infants

337

SouzaandMagalhães (2012)35_/Brazil

--- Observational andlongitudinal

--- 60children(30 PTand30 full-terminfants)

--- GA≤34wand BW≤1500g

--- 12,15,and18m ofCoA

--- PTGwalkedat13.8±2.0m ofCoA(415±59days)andthe CG,at12.3±2m(368±62 days)

--- Nodifferenceswerefound betweenthegroupsat12and 15m

--- Therewasadifference betweenthegroupsonlyat18 m

--- Thecorrelationbetween GAandAIMSat12mofCoA wasnotsignificant

--- Althoughnodifferencewasfound inAIMSat12and15m,powerwas 0.95atbothages.Theseresultsraise questionsaboutthediscriminatory powerofAIMStoidentifythegross motordelayinBrazilianchildren after12m

--- Limitations:limitedsamplesize andthenon-inclusionofthe economiclevelasacriterionfor matching;theuseofimportedtests; andtheuseofparents’reportsto allowthecomparisonofthetimeto gaitacquisition

Maiaetal. (2011)34_/Brazil

--- Longitudinaland comparative

--- 48children(24 PTand24 full-term)

--- GA32<36.5w

---4and6mofCoA

--- Therewasadifference betweenthegroupsinthe standingpositionat4m;and at6m,intheprone,sitting andstandingpositions

--- Thetotalscoresat6m indicatedadifferencebetween thegroups,withthePT showinglowerscores

--- Nodescription --- Inthetotalscoreandinthe percentile,at4mofCoA,therewas nogreatdifferenceinthefour positions.At6m,thefull-termgroup showedahigherscoreinthefour AIMSpositions

---Limitationsregardingsamplesize andtheinclusionofchildrenfrom otherregionsofBrazil

deCastroetal. (2007)37_/Brazil

--- Exploratory

--- 55PT

--- GA<37w

--- Between4and5 mofCoA

--- GAbetween29and34w: 26%(n=8)withpercentile<10

--- GAbetween35and36w: 4%(n=1)withpercentile<10

--- Consideringallthesample (GA<37w):

16.4%(n=9)with percentile<10

--- Thepercentage

ofchildrenwithAIMSscore below

percentile10washigher amongthose

bornatlowerGA(29to34 w)

--- Morepreterminfants(29---34wof GA)hadlowerscoreswhenassessed bytheAIMS,whencomparedtothe PTwith35and36wofGA

--- Theresultsreinforcetheneedfor moredynamictherapeutic

(11)

338

Fuentefria

RN

et

al.

---Cross---sectional

---182PMTand LBW

---GA<37w

---2---4m;4---6m; and6---8m(Three independentage groups

---4---6m:

47%ofsamplewithatypicalMD ---6---8m:

36%ofsamplewithatypicalMD

---ThereweredifferencesinMD ofthe3agegroups,when comparingCoAof chronologicalage

---Nodescription ---Thefindingssuggestthatthe correctedageisthebestwayto assesstheactualperformanceof preterminfantsatrisk,especiallyin thefirstyearoflife

---Studylimitationsregardingdesign andlackoffollow-upofchildren olderthan12m

---Cross-sectional

---70PMT (CGof43PMT fromanother study)

---GA<37wand BW<2500g

---Between0and6 mofCoA

---1m:

30%withdelay(percentile<10) ---2m:

20%withdelay(percentile<10) ---3rdm:

40%withdelay(percentile<10) ---4thm:

33%withdelay(percentile<10) ---5thm:

33%withdelay(percentile<1 0)

---6thm:

43%withdelay(percentile<10)

---Therewerenodifferencesin thetotalscoreofthePMT infantsbyAIMSatanyofthe comparedages

---Nodescription ---TheseresultssuggestthatPMT infantsfromdifferentregions, despitebeingsubmittedtodifferent environmentalinfluences,have similarMD

---Itisrelevanttocreatefollow-up programsforat-riskinfantsaccording totheregionormunicipalitywhere theylive

---Althoughthesamplesofinfants studiedwereconsidered

homogeneous,inrelationtoGAand BW,differenceswereobservedin someagegroupsevaluated

(12)

differences between Brazilian, Canadian, and Greek chil-dren,found inthatcomparativestudyofthreepopulation samples,prevailed upto15 monthsof age;a representa-tiveportionoftheBraziliansample(34.6%)hadlowermotor performancethantheexpected.Accordingtotheauthors,29 theresultsmayindicateadifferenttrajectoryinMD, pos-sibly influencedbysociocultural factorspertinenttochild care.

RegardingthemainresultsrelatedtoMDwhenassessed byAIMS,thereisacertainheterogeneityinthedescription ofmotoroutcomes.Onlytwostudies11,12_discussed_the dif-ferencesobserved in motor acquisitionson each subscale (prone,supine,sitting,andstanding),showingthe percent-ageof pretermchildrenversuschildrenborn atterm that scoredthe assessedacquisition.Pinetal.11 _described _this dataintheirstudyofMDofpreterminfantsbornata gesta-tional age ≤29 weeks and infants born at term, assessed at 4 and 8 months of CoA. At the age of 4 months, all full-terminfantswereabletoplaywiththeirhandsonthe midline, in comparisonwith 81% of preterm infants; at 8 monthsof CoA, preterm infantsdid notprogress asmuch asexpected,sincemanywerenotabletositindependently (25%vs.90%).

Pin et al.12 _followed-up_this _cohort _until ₁₈ _months_of CoA,anddiscussedthedifferencesofeachevaluated acqui-sition. At 12 months of CoA, more full-term infants than preterminfantsreached thetotalscorein thesitting sub-scale(94%vs.68%);moreover,alargernumberofchildren inthecontrolgroupwereabletoperformlateralgaitalong apieceoffurnitureinthestandingsubscale(90%vs.70%). At18monthsofCoA,almostallfull-termchildrenreached thetotalAIMSscore;however,17prematurechildrenwere unabletodoso(37%vs.2%).

Several studies have compared the MD of preterm and full-term children in the first 2 years of life and demonstrated that the former had an inferior motor performance.10---13,23,31 _Of _the ₂₃ _selected _articles, ₁₄ observed significant differences in motor performance between preterm andfull-term infants; however, theage whenthedifferencesareidentifiedvaried.

Conversely, two studies20,26 _failed _to _observe_a signifi-cant difference in the MD of preterm infants versus that offull-terminfantswhenCoAwasconsidered.Restiffeand Gherpelli26_demonstrated_that_the_means_of_the_gross_scores of43low-riskpretermnewbornsweresimilar,afterage cor-rection,totheAIMSstandardsinthe differentagegroups overthe13-monthofCoAperiod.Cabraletal.20_also_stated that, when comparing a group of preterm (n=15) with a groupoffull-terminfants(n=15)at4and6months,there wasnosignificantdifferenceinAIMStotalscore,aswellas intheproneandsittingsubscalescores.Inthesetwo stud-ies,the methodologicalcharacteristics, such asthe small samplesize20_and_the_inclusion_of_preterm_infants_with_low riskforneurologicallesionandneuromotordisorders,26_may haveinfluencedthedescribedfindings.

Corroborating these findings, Manacero and Nunes32 statedthatthemotorperformanceofpreterminfants with-outneurologicaldisorders, evaluatedat the40th weekof gestationalage,inthefourthandeighthmonthsofCoA,was normalbytheAIMSscale.Thepreterminfantsshoweda nor-malprogressivesequenceofmotorskillonsetinallassessed postures(prone,supine,sitting,andstanding),expressedby

themeanpercentileof43.2---45.7%,consideredadequatein theAIMS.32

Among the studies that highlighted significant differ-encesinmotorperformancebetweenpretermandfull-term infants,acriticalanalysiswasperformedbasedontheageat theassessments.At4monthsofCoA,threestudiesshowed differences.10---12 _However, _only _two _of _these _established thiscomparativeanalysisinvolvingextremepreterminfants, withacontrolgroupoffull-terminfants.

Pinet al.11 _described _lower_scores _in _all _subscales_and inthe total scale score,noting that preterm infants with gestationalage≤29weekshavemotorskills thatprogress differentlyfromtheir full-termpeersin thefourpostures assessed at 4 months of CoA. Pin et al.12 _also _reported lower total AIMS scores for preterm infants in this age groupwhencomparedwiththecontrolgroup, demonstrat-inglowerscoresinthesupine,prone,andsittingsubscales. Differencesin theMDof preterm andfull-term infants werealsodescribedat6monthsofCoA.Fivestudiesshowed that preterm infants had lower total AIMS scores in this agegroupwhencomparedtothosebornatterm.10,13,23,33,34 Inthe studyby Wangetal.,33 _preterm _infants_scored sig-nificantly lower than the control group in all subscales. However,although theyshowedlower scores at 6months ofCoA,theyreachedtheMDoftheir full-termpeersover the18 months of CoA. Maia et al.34 _also_described _lower scoresinthegroupofpreterminfantsinthefourpositions assessedbytheAIMS.

The differences found between preterm and full-term infantsat4and6monthsofCoAsupportandreinforcethe importanceofearlyassessmentinthefollow-upasearlyas inthefirst6monthsofCoA,especiallyinhigh-riskpreterm infants.23 _At ₈ _months _of _CoA, _four _studies _found differ-encesintheAIMStotalscorebetweenpreterminfantsand theirfull-term peers.10---12,24 _Of_these, _two_studies, _by _Pin etal.11,12_involved_the_evaluation_of_the_motor_performance ofextremepreterminfants(thosewithgestationalage≤29 weeks).Theauthors11,12 _described_{significantly}_lower_total scoresthanthoseobservedforthecontrols,aswellaslower scores in the sitting and standing subscales, demonstrat-ing a motor delay in more vertical postures in this age group.

FivestudiesfounddifferencesinMDat12monthsofCoA, indicatinglowertotalscoresinpretermchildren.10,12,13,23,33 In three of these studies, extreme prematurity was the assessed group, indicating there is a specific trajectory of MD that reflects a variant of the typical MD in this population.12,13,33 _Pin _et _al.12 _found _lower _scores _in _the prone,sitting, and standing subscales. Wang etal.33 _also stated that preterm infants differed fromtheir full-term peersinthestandingsubscaleinthisagegroup.

(13)

Table2 MotordelaypercentageinpretermchildrenassessedbyAIMS.

Author/year Gestationalage Correctedage Motordelay

Spittleetal.(2015)17 _<30_w ₄_m 8m 12m

22%(percentile<10) 26%(percentile<5) 36%(percentile<5)

Prinsetal.(2010)36 ₃₂_<₃₄_w ₃_m

9m

12% 32%

Snideretal.(2008)22 _<32_w ₃_m _37%_(percentile_<₁₀₎

deCastroetal.(2007)37 ₂₉_<₃₄_w 35<36w

Between4and5m Between4and5m

26%(percentile<10) 4%(percentile<10)

Burgeretal.(2011)25 ₂₇_<₃₆_w ₁₂_m _19%_(percentile_<₅₎

Formigaetal.(2015)38 _<37_w _4---6_m

6---8m

47% 36%

Formigaetal.(2013)21 _<37_w ₁_m

2m 3m 4m 5m 6m

30%(percentile<10) 20%(percentile<10) 40%(percentile<10) 33%(percentile<10) 33%(percentile<10) 43%(percentile<10)

Wangetal.(2010)23 ₂₄_<₃₅_w ₆_m

12m

30.1% 16.1%

Cabraletal.(2014)20 _<37_w _4---6_m _53%_(percentile_≤₅₎

Formigaetal.(2010)31 _Mean_GA₌₃₂_w _4---5_m

5---6m 7---8m

40% 40% 30%

AIMS,AlbertaInfantMotorScale;w,weeks;m,months;GA,gestationalage.

Regardingindependentgait,threestudiespresented evi-dence that preterm infants acquire this ability at a later agethanthosefull-term.24,27,35_Restiffe_and_Gherpelli24_and Souza and Magalhães35 _reported _that _there _is _a _delay _of approximatelyonemonth, witha meanof13.8monthsof CoA for preterm infants and 12.3 months for the control group.Inturn,Nuysinketal.27 _reported_that_children_born atlessthan30weeksofgestationalagestartwalking inde-pendentlyapproximatelythreemonthsaftertheirfull-term peers,evenwithagecorrection.Inthisstudy,27 _the_mean ageofindependentgaitacquisitionforpreterminfantswas 15.7monthsofCoA.

For Pin et al.,11,12 _the _significant _differences _in _motor performance between preterm and full-term infants over the 18 months of CoA appearto be related to the delay inmotor skilldevelopmentinthe moreverticalpositions, suchassittingandstanding,positionsthatrequiregreater muscle strength and antigravity motor control. Signs of trunk dystonia or imbalance between flexorand extensor forceswerefound morefrequentlyinpreterminfantsand overtime,possiblybecausethe demandfor postural con-trolmadetheinadequateflexorcontrolinthetrunkmore apparent, leading to a delay in the capacity tomaintain sittingandstandingpostures,affectingtheabilitytowalk independently.

Although it is important to identify differences in the motor performance of preterm infants in different age groups, it is also important to identify the motor delay percentage in this population. Therefore, some studies17,20---23,25,31,36---38_presented_the_motor_outcomes_based ontheAIMSpercentile,describingthepercentageofdelay foundinpreterminfants(Table2).

Tenstudiesthatusedthisapproachwereretrieved, show-ingavariedpercentageofevaluatedmotor delay,ranging from 4% to 53%, depending at what age the baby was evaluatedinthe firstyearof life.It isobserved thatfour studiesdefinedthegestationalageofthesampletoinclude onlymoderate and/orextreme prematureinfants17,22,36,37_; the others involved the outcome analysis, considering a broaderrangeofgestationalage.Extremepreterminfants hada22---37%delayatthecorrectedagesof3---4months,17,22 and 26---36% at the ages of 8 and 12 months.17 Moder-atelypreterminfantsappeartohavebetteroutcomesat3 months,witha12%motordelay;however,thisfactdoesnot seemtobeconfirmedwhentheageof9monthsisassessed (32%).36

Among the variables associated with motor delay, it wasobservedthatlowerbirth weightwasassociatedwith lowergrossAIMSscoreinthreestudies.13,23,24_In_turn,_some studies didnotfindthis association.19,32,36 _Other _variables associated with poor motor outcome refer to PIVH (peri-intraventricularhemorrhage),chroniclungdisease,pre-and post-natalcorticosteroids,andlowerApgarscore.12 Ethnic-ity, low maternal schooling, and young maternal age are socialandenvironmentalfactorsthatalsohaveasignificant influenceonpretermMD.23,27

(14)

assessmentoftheincludedstudieswasalsoalimitationof thepresentreview.Forfuturestudies,asystematicreview of publications involving standardized assessments of the motorperformanceofpreterminfantsinthepre-schooland schoolyearsissuggested,asthereisaconcernthat prema-tureinfantsmaybemorevulnerablewhenenteringschool age.

Motordelay,aswellasthedifferencesinMDinpreterm infants,areassociatedwiththebiologicalfactorsinvolved, suchasgestationalage,birthweight,cerebralwhitematter lesion,39_and_associated_morbidities.40_{Additionally,}_adverse socioculturalconditionscanaggravatethechildren’srisk,29 withapoorprognosisfortheirdevelopment.Pretermbirth challengesmotor controldevelopment,asthechild starts the extrauterine life with immature and more vulnerable centralandsensory-motorsystems.Asaresult,oneofthe most frequent sequelae is the lack of adequate postural controlduringmotor activities.41 _Thus,_healthcare profes-sionalsmustbeattentivetothedifferentriskfactorsandthe MDofthepreterminfant,inordertodetectdeficitsearly, referringthechildandthefamilyforearlyintervention.

Conclusion

Mostoftheanalyzedstudiessoughttoidentifydifferencesin grossmotordevelopmentthroughtheAIMSbetweenpreterm and full-term infants at differentagesof evaluation. The studiesindicateaninferiormotorperformanceofpreterm infants in the first 18 months of CoA, either through the comparativeanalysiswiththeCanadianAIMSdataor with thedataobtainedfromacontrolgroup,consistingof chil-drenbornatterm.Dependingontheageoftheassessment and the sample characteristics, a variable percentage of motordelaywasidentifiedinpreterminfants.Lowmaternal schoolingandyoungmaternalage,aswellasfactorsrelated toprematurity,suchaslowerbirthweight,PIVH,andchronic lungdisease,wereassociatedwithatypicalmotoroutcome intheAIMS.

Thus,childrenbornprematurelyandinunfavorable envi-ronmentalandsocialconditionsmaybemorevulnerableto motorproblemsataveryearlyage.Therefore,itiscrucial that the follow-up services of at-riskinfants have strate-gies for the evaluation and follow-up of the gross motor developmentof preterminfants, fromthedischarge from theneonatalICUtothefirst2yearsofthechild’slife;AIMS is atool indicated toidentifyatypical motorbehaviorsin thispopulation.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

References

1.Shapiro-Mendoza CK, Lackritz EM. Epidemiology of late and moderate pre-term birth. Semin Fetal Neonatal Med. 2012;17:120---5.

2.BehrmanRE,ButlerAS.Pretermbirth:causes,consequences, and prevention. In: Committee on understanding prema-ture birth and assuring healthy outcomes. Washington, DC:

Institute of Medicine of the National Academies, National AcademiesPress;2007.

3.AmericanAcademyofPediatricsCommitteeonFetusand New-born.Hospitaldischargeofthehigh-riskneonate.Pediatrics. 2008;122:1119---26.

4.StoinskaB,GadzinowskiJ.Neurologicalanddevelopmental dis-abilities inELBW and VLBW: follow up at 2 years ofage. J Perinatol.2011;31:137---42.

5.RebageV,Ruiz-EscusolS,Fernández-VallejoM,Montejo-Ga˜nán I,García-I˜niguezJP,Galve-PradelZ,etal.Neurologicalnewborn inourcenterandfollow-up.RevNeurol.2008;47:S1---13. 6.RugoloLM.Crescimentoedesenvolvimento alongoprazodo

prematuroextremo.JPediatr(RioJ).2005;81:S101---10. 7.HighRiskFollow-upWorkingGroup(KowloonRegion).

Neurode-velopmental outcomes of extreme-low-birth-weight infants born between 2001 and 2002. Hong Kong Med J. 2008;14: 21---8.

8.SoleimaniF,VameghiR,HemmatiS,HemmatiS,Salman-Roghani R.Perinatalandneonatalriskfactorsforneurodevelopmental outcomeininfantsinKaraj.ArchIranMed.2009;12:135---9. 9.AmorimRC,LaurentinoGE,BarrosKM,FerreiraAL,MouraFilho

AG,RaposoMC.Programadesaúdedafamília:propostapara identificac¸ãodefatoresderiscoparaodesenvolvimento neu-ropsicomotor.RevBrasFisioter(SãoCarlos).2009;13:506---13. 10.Formiga CK, Linhares MB. Motor development curve from

0 to 12 months in infants born preterm. Acta Paediatr. 2011;100:379---84.

11.PinTW,DarrerT,EldridgeB,GaleaMP.Motordevelopmentfrom 4to8monthscorrectedageininfantsbornatorlessthan29 weeks’gestation.DevMedChildNeurol.2009;51:739---45. 12.PinTW,EldridgeB,GaleaMP.Motortrajectoriesfrom4to18

monthscorrectedageininfantsbornatlessthan30weeksof gestation.EarlyHumDev.2010;86:573---80.

13.vanHaastertIC,deVriesLS,HeldersPJ,JongmansMJ.Early grossmotordevelopmentofpreterminfantsaccordingtothe AlbertaInfantMotorScale.JPediatr.2006;149:617---22. 14.DarrahJ,BartlettD,MaguireTO,AvisonWR,Lacaze-Masmonteil

T.Haveinfantgrossmotorabilitieschangedin20years?A re-evaluationoftheAlbertaInfantMotorScalenormativevalues. DevMedChildNeurol.2014;56:877---81.

15.Valentini NC, Saccani R. Brazilian validation of the Alberta InfantMotorScale.PhysTher.2012;92:440---7.

16.Saccani R, Valentini NC. Reference curves for the Brazilian AlbertaInfantMotorScale:percentilesforclinicaldescription andfollow-upovertime.JPediatr(RioJ).2012;88:40---7. 17.SpittleAJ,LeeKJ,Spencer-SmithM,LoreficeLE,AndersonPJ,

DoyleLW.Accuracyoftwomotorassessmentsduringthefirst yearoflifeinpreterminfantsforpredictingmotoroutcomeat preschoolage.PLoSOne.2015;10:e0125854.

18.Shapiro-Mendoza CK, Lackritz EM. Epidemiology of late and moderate preterm birth. Semin Fetal Neonatal Med. 2012;17:120---5.

19.Fetters L, Huang HH. Motor development and sleep, play, and feeding positions in very-low-birth weight infants with and without white matter disease. Dev Med Child Neurol. 2007;49:807---13.

20.Cabral TI, Pereira da Silva LG, Tudella E, Simões Martinez CM. Motordevelopment and sensory processing: a compara-tivestudybetweenpretermandterminfants.ResDevDisabil. 2014;36C:102---7.

21.FormigaCK,NonatoJC,AmaralLE,FagundesRR,LinharesMB. Comparac¸ãododesenvolvimentomotordelactentespré-termo de duas amostras regionais brasileiras. J Hum Growth Dev. 2013;23:352---7.

(15)

23.WangTN,HoweTH,HinojosaJ,HsuYW.Posturalcontrolof pre-terminfantsat6and12monthscorrectedage.EarlyHumDev. 2010;86:433---7.

24.RestiffeAP,GherpelliJL.Differencesinwalkingattainmentages between low-riskpretermand healthy full-terminfants. Arq Neuropsiquiatr.2012;70:593---8.

25.BurgerM,FriegA,LouwQA.Generalmovementsasapredictive tooloftheneurologicaloutcomeinverylowandextremelylow birthweightinfants---aSouthAfricanperspective.EarlyHum Dev.2011;87:303---8.

26.Restiffe AP, Gherpelli JL. Comparison of chronological and corrected ages in the gross motor assessment of low-risk preterminfantsduringthefirstyearoflife.ArqNeuropsiquiatr. 2006;64:418---25.

27.NuysinkJ,vanHaastertIC,EijsermansMJ,Koopman-Esseboom C,HeldersPJ,deVriesLS,etal.Predictionofgrossmotor devel-opmentandindependentwalkingininfantsbornverypreterm using the Testof Infant MotorPerformance and the Alberta InfantMotorScale.EarlyHumDev.2013;89:693---7.

28.PiperMC,PinnellLE,DarrahJ,MaguireT,ByrnePJ.Construction andvalidationoftheAlbertaInfantMotorScale(AIMS).CanJ PublicHealth.1992;83:S46---50.

29.Saccani R,Valentini NC.Cross-cultural analysisofthemotor developmentofBrazilian,GreekandCanadianinfantsassessed with the Alberta Infant Motor Scale. Rev Paul Pediatr. 2013;31:350---8.

30.Valentini NC, Saccani R. Escala Motora Infantil de Alberta: validac¸ão para uma populac¸ão gaúcha. Rev Paul Pediatr. 2011;29:231---8.

31.Formiga CK, Cezar ME, Linhares MB. Avaliac¸ão longitudinal do desenvolvimento motor e da habilidade de sentar em crianc¸as nascidas prematuras. Fisioter Pesqui (São Paulo). 2010;17:102---7.

32.Manacero S, Nunes ML. Evaluation of motor performance of preterm newborns during the first months of life using the Alberta Infant Motor Scale (AIMS). J Pediatr (Rio J). 2008;84:53---9.

33.WangLY,WangYL,WangST,HuangCC.UsingtheAlbertaInfant Motor Scale to early identify very low-birth-weight infants withcysticperiventricular leukomalacia.BrainDev.2013;35: 32---7.

34.MaiaPC,SilvaLP,OliveiraMM,CardosoMV.Motordevelopment ofpretermand terminfants---usingtheAlbertaInfantMotor Scale.ActaPaulEnferm.2011;24:670---5.

35.SouzaES,MagalhãesLC.Desenvolvimentomotorefuncionalem crianc¸as nascidaspré-termoeatermo:influência defatores de risco biológico e ambiental. Rev Paul Pediatr. 2012;30: 462---70.

36.PrinsSA,vonLindernJS,vanDijkS,VersteeghFG.Motor devel-opmentofprematureinfantsbornbetween32and34weeks. IntJPediatr.2010,2010.pii:462048.

37.deCastroAG,LimaMdeC,deAquinoRR,EickmannSH.Sensory oralmotorandglobalmotordevelopmentofpreterminfants. ProFono.2007;19:29---38.

38.Formiga KM, Vieira ME, Linhares MB. Avaliac¸ão do desen-volvimentodebebêsnascidospré-termo:acomparac¸ãoentre idadecronológica e corrigida. J Hum Growth Dev. 2015;25: 230---6.

39.WestrupB. Newborn Individualized Developmental Careand AssessmentProgram(NIDCAP)---family-centered developmen-tallysupportivecare.EarlyHumDev.2007;83:443---9.

40.StoinskaB,GadzinowskiJ.Neurologicalanddevelopmental dis-abilitiesin ELBW and VLBW: follow-up at 2 years of age. J Perinatol.2011;31:137---42.