Body structure, function, activity, and participation in 3- to 6-year-old children born very preterm: An ICF-based systematic review and meta-analysis

Abstract

Background. The World Health Organization's International Classification of Functioning, Disability, and Health framework, Children and Youth Version (ICF-CY), provides a valuable method of conceptualizing the multidomain difficulties experienced by children born very preterm (VP). Reviews investigating motor outcomes at preschool age across ICF-CY domains are lacking. Purpose. The purpose of this review is to identify and compare motor outcomes of 3- to 6-year-old children born VP and children born full-term (FT) within the ICF-CY framework. Data Sources. Four electronic databases and reference lists of included and key articles were searched. Study Selection. Studies comparing motor outcomes of 3- to 6-year-old children born VP ( < 32 weeks' gestation or birth weight < 1500 g) with peers born FT were included. Data Extraction. Two independent authors extracted data and completed quality assessments. Data Synthesis. Thirty-six studies were included. Activity motor performance of children born VP was consistently poorer compared with peers born FT: standardized mean difference (SMD) was -0.71 (95% CI = -0.80 to -0.61; 14 studies, 2056 participants). Furthermore, children born VP had higher relative risk (RR) of motor impairment (RR = 3.39; 95% CI = 2.68 to 4.27; 9 studies, 3466 participants). Body structure and function outcomes were largely unable to be pooled because assessment tools varied too widely. However, children born VP had higher RR of any neurological dysfunction (Touwen Neurological Examination) (RR = 4.55; 95% CI = 1.20 to 17.17; 3 studies, 1363 participants). There were no participation outcome data. Limitations. Limitations include the lack of consistent assessment tools used in VP follow-up at preschool age and the quality of the evidence. Conclusions. Children born VP experience significant motor impairment across ICFCY activity and body structure and function domains at preschool age compared with peers born FT. Evidence investigating participation in VP preschool-age populations relative to children born at term is sparse, requiring further research.