Associação longitudinal entre desenvolvimento motor e prematuridade: uma revisão sistemática com meta-análise explorando os fatores moderadores

Abstract

Preterm children have an atypical outcome in motor development, however, the risk of delay and the magnitude of the effect size of this association in different periods of childhood, as well as, the moderating factors of this association have not been explored, still in the literature, with use of meta-analysis and meta-regression techniques. This study aimed to analyze the association between prematurity and motor development in the literature, to evaluate the risk of motor delay and the magnitude of the effect size, and to identify the potential moderators of this association in childhood. This research is a systematic review with a meta-analysis that followed the protocol PRISMA statement and MOOSE. The search was done in the online databases (EMBASE, PubMed, PsycINFO, Web of Science and SPORTDiscus), in August 2019 and updated in October 2020, with no restriction on the year of publication of the articles using keywords in English referring to motor development, prematurity, longitudinal studies and childhood, combined with Boolean and truncation operators. The eligibility criteria were adopted: longitudinal studies of a prospective cohort that followed preterm and term children in infancy (zero to ten years old); studies that assessment motor development with validated instruments; articles published in English, Spanish and Portuguese. Exclusion criteria: studies that followed high-risk or with disabilities preterm children. The selection of the studies was performed by three independents reviewers by reading the titles and abstracts, and subsequently, the full text to verify if they according to the eligibility criteria. Two meta-analyses were conducted. The first calculated the risk of delayed motor development in different domains according to the cutoff points established in the studies (atypical and typical development). The second calculated the standardized mean difference of the different domains of motor development (total, fine motor and gross motor) between preterm infants and terms in the follow-up evaluation. The risk of bias in individual studies was assessed by two independents reviewers using the New-Castle Ottawa Scale (NOS). A total of 14,182 potentially eligible articles were found, and 41 included in the meta-analysis. The risk of delay in total motor development found was twice as high for preterm children when compared to term children (aOR 3.18, 95% CI 1.91-5.27, p<0.001) at 2 to 8 years. The effect size on total motor development was medium for all age groups first year of life (SMD= -0.75, 95% CI -0.90 -0.61, P<0.001, I²=0, K=10), second year of life (SMD= -0.73, 95% CI -0.96 -0.50, p<0.001, I²=89.99, k=15), and over 24 months (SMD= -0.73, 95% CI -0.95 -0.51, P<0.001, I²=84.3, K=11). Moderators of unfavorable total motor development in preterm children were gestational age, be girl, maternal age and birth weight. The quality of the studies was high md= 7 (4-9) points in NOS. In this sense, the findings of this review demonstrate that preterm children are more likely to have delays in total motor development throughout childhood. Therefore, to assess the changes in the motor development of this population is important to identify delays and to create intervention programs that promote the acquisition of motor skills and minimize gaps. Such, it’s necessary to increase investment in cohort research on this topic, mostly, in countries with low and medium income.