Children born <30 weeks of gestation have more motor impairment than do children born at term (37–42 weeks gestation), but reported outcomes have largely focused on cerebral palsy and developmental coordination disorder. The aim of this study was to compare muscle strength, motor skills, and physical activity (PA) of preschool-aged children born <30 weeks with those born at term. In this cohort study, 123 children born <30 weeks and 128 born at term were assessed. Children were aged ≥4 years, 0 months and <6 years, 0 months’ corrected age at the time of the assessment. Outcomes included grip strength (kg), Movement Assessment Battery for Children 2nd edition (MABC-2), Little Developmental Coordination Disorder Questionnaire, accelerometer-measured PA, and a parent-completed PA diary. Linear regression and mixed effects models were used to examine differences between children born <30 weeks and those born at term. Children born <30 weeks had poorer grip strength (preferred hand; mean difference [95% CI] −0.60 kg [−1.04 to −0.15]) and poorer motor competence (Movement Assessment Battery for Children 2nd edition standard score mean difference −2.17 [−3.07 to −1.27]; Little Developmental Coordination Disorder Questionnaire total score mean difference −5.5 [−9.2 to −2.8]) than term-born children. Children born <30 weeks also completed fewer minutes of accelerometer-measured PA (mean difference −41 minutes [−62 to −20]), more minutes of accelerometer-measured stationary behavior (mean difference 33 minutes [12 to 54]), and more minutes of parent-reported screen time (mean difference 21 minutes [10 to 32]) per day. Preschool-aged children born <30 weeks had poorer muscle strength, motor skills, and PA levels than term-born children. These findings suggest that preschool-aged children born <30 weeks may benefit from enhanced surveillance and PA promotion to improve life-long health outcomes. In our study, children born <30 weeks had reduced muscle strength and poorer motor skills, participated in less PA, and had more stationary and screen behavior than term-born children. These findings emphasize that awareness of multidomain motor deficits in children born <30 weeks’ gestation is needed in clinical practice. Given the associations between higher PA and health benefits and the recognition that PA levels can track from early childhood into adulthood, our study highlights the need for assessment and promotion of PA in preschool-aged children born <30 weeks’ gestation. Lay Summary. Preschool-aged children born <30 weeks’ gestation have poorer strength, motor skills, and physical activity behaviors than their term-born peers. Clinicians and early childhood educators should recognize that the preschool period is a critical time for the assessment and promotion of PA in children born <30 weeks.

Motor impairments are one of the most frequently reported adverse neurodevelopmental consequences in children born < 30 weeks' gestation. Up to 15% of children born at < 30 weeks have cerebral palsy and an additional 50% have mild to severe motor impairment at school age. The first 5 years of life are critical for the development of fundamental motor skills. These skills form the basis for more complex skills that are required to competently and confidently participate in schooling, sporting and recreational activities. In children born at < 30 weeks' gestation, the trajectory of motor development from birth to 5 years is not fully understood. The neural alterations that underpin motor impairments in these children are also unclear. It is essential to determine if early clinical evaluations and neuroimaging biomarkers can predict later motor impairment and associated functional problems at 5 years of age. This will help to identify children who will benefit the most from early intervention and improve functional outcomes at school age. The primary aim of this study is to compare the prevalence of motor impairment from birth to 5 years of age between children born at < 30 weeks and term-born controls, and to determine whether persistent abnormal motor assessments in the newborn period in those born at < 30 weeks predict abnormal motor functioning at 5 years of age. Secondary aims for children born at < 30 weeks and term-born children are: 1) to determine whether novel early magnetic resonance imaging-based structural or functional biomarkers that can predict motor impairments at 5 years are detectable in the neonatal period; 2) to investigate the association between motor impairments and concurrent deficits in body structure and function at 5 years of age; and 3) to explore how motor impairments at 5 years (including abnormalities of gait, postural control and strength) are associated with concurrent functional outcomes, including physical activity, cognitive ability, learning ability, and behavioural and emotional problems. Prospective longitudinal cohort study. 150 preterm children (born at < 30 weeks' gestation) and 151 term-born children (born at > 36 completed weeks' gestation and weighing > 2499g) admitted to the Royal Women's Hospital, Melbourne, were recruited at birth and will be invited to participate in a 5-year follow-up study. This study will examine previously collected data (from birth to 2 years) that comprise detailed motor assessments, and structural and functional brain MRI images. At 5 years, preterm and term, children will be examined using comprehensive motor assessments, including: the Movement Assessment Battery for Children (2nd edition) and measures of gait function through spatiotemporal (assessed with the GAITRite® Walkway) and dynamic postural control (assessed with Microsoft Kinect) variables; and hand grip strength (assessed with a dynamometer); and measures of physical activity (assessed using accelerometry), cognitive development (assessed with Wechsler Preschool and Primary Scale of Intelligence), and emotional and behavioural status (assessed with the Strengths and Difficulties Questionnaire and the Developmental and Wellbeing Assessment). At the 5-year assessment, parents/caregivers will be asked to complete questionnaires on demographics, physical activity, activities of daily living, behaviour, additional therapy (eg, physiotherapy and occupational therapy), and motor function (assessed with Pediatric Evaluation of Disability Inventory, Pediatric Quality of Life Questionnaire, the Little Developmental Co-ordination Questionnaire and an activity diary). For the primary aim, the prevalence of motor impairment from birth to 5 years will be compared between children born at < 30 weeks and at term, using the proportion of children classified as abnormal at each of the time points (term age, 1, 2 and 5 years). Persistent motor impairments during the neonatal period will be assessed as a predictor of severity of motor impairment at 5 years of age in children born < 30 weeks using linear regression. Models will be fitted using generalised estimating equations to allow for the clustering of multiple births. Analysis will be repeated with adjustment for predictors of motor outcome, including additional therapy, sex, brain injury and chronic lung disease. Understanding the developmental precursors of motor impairment in children born before 30 weeks is essential for limiting disruption to skill development, and potential secondary impacts on physical activity, participation, academic achievement, self-esteem and associated outcomes (such as obesity, poor physical fitness and social isolation). An improved understanding of motor skill development will enable targeting of interventions and streamlining of services to children at highest risk of motor impairments.

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. 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. Four electronic databases and reference lists of included and key articles were searched. Studies comparing motor outcomes of 3- to 6-year-old children born VP (< 32 weeks’ gestation or birthweight < 1500 g) with peers born FT were included. Two independent authors extracted data and completed quality assessments. 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 include the lack of consistent assessment tools used in VP follow-up at preschool age and the quality of the evidence. Children born VP experience significant motor impairment across ICF-CY activity, and body structure and function domains compared with term-born peers at preschool age. Evidence investigating participation in VP preschool-age populations relative to children born at term is sparse, requiring further research.