Extreme prematurity is constantly increasing according to the World Health Organization. Currently, in France, about 13,000 very premature infants are born at less than 32 weeks of gestation each year. This situation creates a real public health problem because the increase in the survival of very premature babies leads to an increase in the number of children with disabilities during their development. However, methods to early diagnose and train premature infants at risk of disability are sorely lacking. The goal of this proposal is to overcome these problems.
This current project, PREMALOCOM, represents the clinical translation to premature infants, with additional neuroimaging, of a previous project funded by the ANR 11-BSH2-0070 (NEOLOCOM). In our previous ANR project, we discovered that promoting the crawling of typical newborns on a mini skateboard, the Crawliskate (a new tool, we designed and patented), is an excellent way to stimulate infants’ active whole-body locomotion vital to their later development of posture and locomotion. The method is a promising way to: 1) provide early interventions to accelerate motor and neuropsychological development in infants at heightened risk for developmental delay, such as premature infants, and 2) isolate early signatures of abnormal development.
The specific objectives of this proposal are threefold: First, to determine whether early crawling patterns observed when the newborn is on the Crawliskate can be used to predict whether very premature infants will ultimately be diagnosed with delayed or impaired motor (particularly locomotor) and/or psychological development. Second, to determine if early training in crawling on this mini skateboard will accelerate motor (particularly locomotor) and/or neuropsychological development in very premature infants identified as median or high risk for developmental delay. Third, to understand the early neural substrates of motor disability in very premature infants and neuromotor plasticity following training on the Crawliskate.
Methodology: We will study and follow two groups of very premature infants born between 24 and 32 weeks of gestational age: one without major brain lesions (Study 1) and one with major brain lesions (Study 2). These infants will be recruited before their hospital discharge at the NICU. After their discharge from the hospital, half of the infants in each group will be trained at home by their parents to crawl on the Crawliskate every day for 2 months (Trained) and half of the infants in each group will receive no training but usual clinical follow-up (Control). All infants will be tested for: 1) their crawling proficiency on the Crawliskate at term-equivalent age (just before training for the trained groups) and at 2 months corrected age (CA, i.e., age determined from the date on which they should have been born), and 2) their neurodevelopmental, motor and neuropsychological development between 0 and 12 months CA. In addition, the groups of trained and untrained premature infants presenting major brain lesions (Study 2) will receive two MRI examinations, one performed before their discharge from the hospital and one when they reach 2 months CA.
Expected results: Our first research hypothesis is that between 0 to 2 months of their corrected age, aberrant crawling patterns on the Crawliskate can be identified in premature infants with compromised outcomes. Our second hypothesis is that premature infants trained daily to crawl (for two months after discharge from the NICU) will acquire proficient crawling patterns and develop earlier and more effective motor and neuropsychological development than premature infants who receive no training. Our third hypothesis is that early training of these motor and neuropsychological capacities will be related to improved plasticity and maturation of brain networks dedicated to sensorimotor and potentially cognitive processing.
Project collaborator
Marianne Barbu-Roth
Project team lead
Sylvie Tordjman
Jessica Dubois
Project supported by :
