Introduction
Motor difficulties in preterm children may be observable at an early
age,1,2 and even in the absence of severe impairment,
30 to 50% of preterm and/or low-weight children have mild motor
difficulties.3 It is well known that cerebral palsy
(CP) and other neurological sequelae due to prematurity are associated
poor motor development.1,4,5 However, many of preterm
children do not have any neurological impairment and may demonstrate
more subtle motor difficulties that can later be identified as
Developmental Coordination Disorder (DCD).6 Further,
these mild difficulties may be overlooked by parents and clinicians,
which may lead to a late diagnosis and a delayed necessary intervention
such as physical therapy.
Developmental coordination disorder (DCD) is an impairment of motor
skills that significantly interferes with the child’s performance in
their daily activities, academic performance, and leisure activities in
otherwise healthy children.7 A DCD diagnosis is based
on the Diagnostic and Statistical Manual of Mental Disorders – 5th
edition (DSM-5). 7 The DSM-5 establishes four criteria
for diagnosis: 1) Learning and execution of coordinated motor skills are
below the expected level for age, given opportunities for skill
learning; 2) Motor skill difficulties significantly interfere with
activities of daily living and impact academic/school productivity,
pre-vocational and vocational activities, leisure and play; 3) Onset of
delays is observed in the early developmental period; and 4) Motor skill
difficulties are not better explained by intellectual delay, visual
impairment or other neurological conditions that affect
movement.7
It is estimated that around 6% of the world’s school-age population is
meet criteria for DCD.8,9 However, in the preterm
population, the reported prevalence varies owing to different assessment
tools, cut-off criteria, and the preterm population. There are two
systematic reviews indicating that prematurity increases the risks of
DCD.10,11 The first one evaluated 11 studies and
demonstrated that premature children are at risk three to four times
higher than the general population. The pooled estimation for DCD was
19% and 40.5% depending on the cut-off point used for
diagnosis.10 The second one evaluated 16 studies and
pointed out that preterm infants are six to eight times more likely to
have DCD.11
However, the two systematic reviews10,11 are from more
than 10 years ago, and they did not assess the prevalence of DCD
according to gestational age. Besides, none included studies from
Low-Moderate Income Countries (LMIC), and none compared preterm children
with different gestational ages. All these factors combined justify
conducting a new study with more current articles and a more
comprehensive global sample and expanding the previous group comparisons
to include gestational age. Therefore, we established four aims for this
systematic review and meta-analysis: 1) to investigate the prevalence of
developmental coordination disorder in individuals born preterm; 2) to
investigate the prevalence of developmental coordination disorder in
individuals born preterm according to gestational age; 3) to investigate
the prevalence of DCD in individuals born preterm according to different
assessments cut-offs; 4) to investigate the prevalence of developmental
coordination disorder in individuals born preterm compared to full
terms. The hypothesis is that children born preterm will have higher
prevalence of DCD than children born at term and this prevalence will be
even higher in those born extremely preterm. Also, studies will present
different criteria to identify DCD and varied prevalence rates.