Reduced corticomotor excitability and motor skills development in children born preterm.

The mechanisms underlying the altered neurodevelopment commonly experienced by children born preterm, but without brain lesions, remain unknown. While individuals born the earliest are at most risk, late preterm children also experience significant motor, cognitive and behavioural dysfunction from school age, and reduced income and educational attainment in adulthood. We used transcranial magnetic stimulation and functional assessments to examine corticomotor development in 151 children without cerebral palsy, aged 10-13 years and born after gestations of 25-41 completed weeks. We hypothesized that motor cortex and corticospinal development are altered in preterm children, which underpins at least some of their motor dysfunction. We report for the first time that every week of reduced gestation is associated with a reduction in corticomotor excitability that remains evident in late childhood. This reduced excitability was associated with poorer motor skill development, particularly manual dexterity. However, child adiposity, sex and socio-economic factors regarding the child's home environment soon after birth were also powerful influences on development of motor skills. Preterm birth was also associated with reduced left hemisphere lateralization, but without increasing the likelihood of being left handed per se. These corticomotor findings have implications for normal motor development, but also raise questions regarding possible longer term consequences of preterm birth on motor function.

Motor system development of the preterm and low birthweight infant.

Despite advances in knowledge and technology, accurate prediction of later neuromotor outcomes for infants born preterm remains somewhat elusive. Here we review some of the most recent findings regarding the differential effects of preterm birth and suboptimal fetal growth on neurodevelopment. Evidence from transcranial magnetic stimulation studies is presented that suggests neuromotor development may more directly influence cognitive outcomes than previously recognised. We discuss the role of neuroplasticity in both exacerbating and improving these postnatal outcomes, and possible therapeutic targets for manipulating this. Finally, some developmental care practices that might affect long-term outcomes for these children are discussed.