Abstract:

Introduction:
Over the past 15 years, the survival rate of extremely low gestational age (ELGA) newborns has increased by over 80%. However, the potential consequences on their short- and long-term developmental competencies could be severe. ELGA birth is associated with higher risks for motor, learning, and behavior problems, particularly cognitive impairment, with reported impairment rates in at least one of these domains as high as 70% among the most immature infants. This study aimed to describe the developmental functioning of ELGA children compared to full-term (FT) peers.

Methods:
Developmental functioning was assessed using the Screening of Psychomotor Development 11 (S-PMV11) instrument, which is part of a series of 10 screenings used in Slovakia for Monitoring the Development of Psychomotor Function and Screening for Developmental Difficulties in primary pediatric practice. The study included 15 ELGA infants born in 2017 with gestational age ≤ 28 weeks and a comparison group of 1305 FT infants born in 2018 with gestational age ≥ 38 weeks. Parental assessments of developmental functioning were conducted when the children were between 26 and 35 months old.

Results and Discussion:
Significant differences were found in the parental reports of developmental functioning between FT and ELGA children aged 26 to 35 months (MFT = 17.58, SDFT = 3.10; MELGA = 12.93, SDELGA = 5.44; U = 4450.00, p = .00). FT children's developmental functioning fell within the low-risk range (≥ 26th percentile) according to the established S-PMV11 cutoff, while ELGA children's fell within the high-risk range (≤ 10th percentile). Consistent with previous studies, the significant disparities in motor skills, social behavior, speech expression, and self-care were noted, with ELGA children perceived by their parents as less mature and less prepared for kindergarten. The results suggest a growing intergroup divergence in developmental functioning, known as the Matthew effect, between ELGA and FT children aged 26 to 35 months. This outcome may be due to the cascade effect commonly observed in premature children, which influences further development. Delayed psychomotor development often becomes a precursor to neurodevelopmental disorders in later life. A limitation of the study is the small number of ELGA participants.

Conclusion:
Prognostically, monitoring the achievement of developmental milestones is significantly indicated for this high-risk developmental group. Equally crucial is providing accessible and adequate support, resources, and interventions for premature children and their families, as the long-term neurodevelopmental consequences of extreme prematurity extend from preschool through adolescence to adulthood.

Acknowledgement:
The study was supported by the VEGA project: 1/0534/22: Psychometric properties and validity of the Screening of Psychomotor Development (S-PMV) as a monitoring method for early detection of developmental difficulties in children.

Keywords:

Developmental functioning, extremely preterm children, developmental delay, developmental screening.