Monitoring motor development trajectories in preterm infants: correlation with neonatal characteristics, clinical and neurocognitive outcomes

Despite significant advances in neonatology increasing survival rates for Very Low Birth Weight (VLBW) and Very Low Gestational Age (VLGA) infants, the risk of long-term Neurodevelopmental Impairment (NDI) remains high. This PhD thesis aimed to improve early risk stratification for NDI by integrating functional neurological assessments and acute systemic comorbidity markers. The research was structured into two interconnected studies. Part A prospectively studied 98 VLBW/VLGA infants, validating the General Movements (GMs) assessment as an effective early warning system. Infants exhibiting anomalous GMs trajectories were up to 16 times more likely to experience motor delay at 6 months Corrected Age (CA). Furthermore, correlations across motor, language, and cognitive domains supported the developmental cascade hypothesis, suggesting early motor mastery catalyses broader cognitive and linguistic advancement. Part B examined systemic instability via early Acute Kidney Injury (AKI), defined according to serum creatine or urinary output criteria (UO), in a retrospective cohort of 339 infants. Extremely Low Birth Weight (ELBW), non-steroidal anti-inflammatory drugs (NSAIDs), and inotropes were identified as significant risk factors. Crucially, while AKI UO was associated with poorer short-term clinical outcomes (longer hospitalization, lower growth Z-scores), its link to long-term NDI at 12-24 months CA disappeared after adjusting for critical neonatal comorbidities (periventricular leukomalacia, late onset sepsis, bronchopulmonary dysplasia). This suggests that AKI may functions as a marker of overall severe systemic vulnerability. In conclusion, this work validates GMs as a crucial, independent predictor of early motor development, providing opportunity to guide parental counselling and early integrated rehabilitation. Conversely, systemic markers require refinement. Future research must focus on refining AKI definitions to optimize its detection, particularly through the adaptation of UO thresholds specifically for preterm infants to enhance the marker’s discriminative performance for predicting long-term outcomes.