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Relationship Between Spontaneous Kicking and Age of Walking Attainment in Preterm Infants With Very Low Birth Weight and Full-Term Infants

SF Jeng, PT, ScD, is Associate Professor, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, and Adjunct Physical Therapist, Department of Rehabilitation and Physical Medicine, National Taiwan University Hospital, No. 7 Chun-Shan South Rd, Taipei, Taiwan (jeng{at}ntu.edu.tw)
LC Chen, PT, MS, is a doctoral student, Department of Kinesiology; University of Maryland, College Park, Md
KI Tsou, MD, is Professor, School of Medicine, College of Medicine, Fu-Jen Catholic University, and Deputy Director of Education and Neonatologist, Cardinal Tien Hospital, Taipei, Taiwan
WJ Chen, MD, ScD, is Professor, Institute of Epidemiology, College of Public Health, National Taiwan University, and Adjunct Research Fellow, Department of Psychiatry, National Taiwan University Hospital
HJ Luo, PT, MS, is Physical Therapist, Department of Rehabilitation and Physical Medicine, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
Dr Jeng and Ms Li-Chiou Chen provided concept/idea/research design and data collection. Dr Jeng provided writing and project management. Ms Li-Chiou Chen, Dr Wei Chen and Mr Luo provided data analysis. Dr Jeng and Dr Tsou provided fund procurement. Dr Tsou provided subjects, and Mr Luo provided clerical support. Ms Li-Chiou Chen and Dr Wei Chen provided consultation (including review of manuscript before submission). The authors thank the infants and their parents for their participation in this study; Ms Hsian-Feng Chen and Ms Shiu-Ying Yu for their assistance in data collection; Mr Hong-Nan Chen for his assistance in program development; and Dr Linda Fetters, Dr Tung-Wu Lu, and Ms Hua-Fang Liao for their guidance during the study

Address all correspondence to Dr Jeng

Background and Purposes. Although early kicking differences have been reported for preterm infants without overt cranial sonographic abnormalities, their functional importance remains unclear because no outcomes have been measured. Therefore, the first purpose of this prospective study was to examine the age of walking attainment in preterm infants who had very low birth weight (VLBW) but no overt neurosonographic abnormalities and full-term infants without known impairments or pathology. The second purpose was to examine the relationship between spontaneous kicking and age of walking attainment in these infants. Subjects and Methods. Twenty-two preterm infants and 22 full-term infants were examined for kicking movements at 2 and 4 months corrected age and were followed up for age of walking attainment until 18 months corrected age. Results. Survival analysis showed that infants with VLBW attained walking ability at older ages than full-term infants after correction for prematurity. Cox proportional-hazards regression analyses for all infants revealed that a high hip-knee correlation at 2 months corrected age, a high kick frequency at 4 months corrected age, and a short intra-kick pause together with a low variability in interlimb coordination at 2 and 4 months corrected age were all associated with a decreased rate of walking attainment. Discussion and Conclusion. The results indicated that preterm infants who had VLBW but no overt neurosonographic abnormalities had an increased risk of delayed walking attainment compared with full-term infants. Alterations of spontaneous kicking may predict a decreased rate of walking attainment in both preterm and full-term infants.

Key Words: Kicking movement • Kinematic analysis • Prematurity • Walking

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