Background: Fine motor development during early infancy reflects emerging hand–eye coordination, reach-to-grasp abilities, and cortical-sensory integration. High-risk NICU infants are particularly vulnerable to fine motor delay due to neonatal complications such as hypoxia, seizures, and neuroimaging abnormalities. Early prediction of fine motor outcomes is essential to guide timely intervention and prevent long-term deficits.

Objective: To develop and validate a clinical predictive model for estimating 6-month Fine Motor outcomes in high-risk NICU infants using significant prenatal, perinatal, and neonatal risk factors.

Methods: A cross-sectional study was conducted on 284 high-risk NICU graduates. Thirty-one potential risk factors were screened, and variables significantly correlated with the Ages and Stages Questionnaire, Third Edition (ASQ-3) Fine Motor score were entered into stepwise linear regression. The final model identified significant predictors contributing to the 6-month Fine Motor score. Predicted scores were categorized as High Risk/No Risk and compared with actual ASQ-3 classifications to determine Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and Overall Accuracy.

Results: The predictive model identified key neonatal and perinatal factors significantly associated with reduced fine motor performance, including neurological complications and early physiological instability. The model demonstrated clinically relevant accuracy for identifying infants at risk of fine motor delay, with satisfactory sensitivity and strong specificity and negative predictive value.