Denver Developmental Screening Tool
Title: Longitudinal study of sleep behavior and motor development in low-birth-weight preterm children from infancy to preschool years
Authors: Sonia Manacero and Magda Lahorgue Nunes
Purpose: The purpose of this study was to examine the relationship between sleep behaviors and the development of low-birth-weight preterm children from infancy to preschool years. The researchers hypothesize that sleep disturbances could be corelated to delayed motor development.
Study population: The population of this study consisted of 41 preterm infants that were born less than 37 weeks’ gestation with a low birth weight that was defined as less than or equal to 1500 grams. The exclusion criteria were complications participating in the study in the future, neurological complications, death, or inability to reach the family.
Methods: All of the participants were recruited from the NICU of a tertiary care teaching hospital in Porto Alegre, Brazil. Each participant was assessed and reassessed using various outcome measures that examined their motor development and sleep behaviors at 6 months of corrected age, 12 months of corrected age, and between 4 and 5 years old.
Outcome Measures: To assess the infants’ motor development, the researchers administered the Denver Developmental Screening Test (Denver II) and Alberta Infant Motor Scale (AIMS). The validated Brazilian version of both of these outcome measures were utilized to assess personal-social, fine motor-adaptive, language, and gross motor development, as well as quality of weight-bearing, posture, and anti-gravity skills in various positions. Once the participants were between the ages of 4 and 5, a validated Brazilian version of the Pediatric Evaluation of Disability Inventory (PEDI) was utilized to indicate any delay in motor development.
At 6 and 12 months of corrected age, the parents completed a validated Brazilian version of the Brief Infant Sleep Questionnaire (BISQ) to identify their infant’s sleeping behaviors. Once the participants were between the ages of 4 and 5, the BISQ was used to reassess the children’s sleep behaviors and disturbances.
Intervention: This was a longitudinal study that assessed motor development and sleep behavior changes over a period of time through outcome measures. It did not introduce an intervention to the study population.
Results: This study reported a significantly higher number of infants sleeping on their bellies at 12 months of age in comparison to 6 months, in addition to a decrease in the duration of daytime sleeping. Most of the infants had a suspected developmental delay at 6 and 12 months of corrected age according to both the Denver II and AIMS (no difference between these two scales). There was also an association between the development and lateral sleep position in the infants at 6 months of corrected age, yet there was no significant association was detected at 12 months of corrected age. It was also reported that 18 of the 36 preterm infants between 4 and 5 years of age had sleep disturbances, yet all previously suspected delay observations were reversed.
Strengths/Limitations: A strength of this study was the validity and reliability of the outcome measures that were utilized to assess motor development; both the Denver II and AIMS reported the same findings. A few limitations of this study include the small sample size, participant drop-out, use of different scales at different ages, and little research assessing motor development and sleep characteristics in healthy preterm infants.
Conclusion: The results from this study showed that sleep disturbances observed at 6 months improved as the infants aged. The observed motor delays at 6 and 12 months were also no longer detected between 4 and 5 years old. In conclusion, sleep quality of preterm infants with low birth weights may be correlated with motor development delays in early infancy. More research should be conducted to further investigate this correlation.
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Hi Becca! Great article summary. It makes sense that the infants sleeping patterns improved as they age, as that is what we usually see with children. I never thought about there being a correlation between motor delays and sleep patterns and I am interested in why that would be and if there have been other studies about this correlation. I am wondering what would contribute to the reversal of the delays that they observed?