The role of spontaneous general movement assessment in the neurological outcome of cerebral lesions in preterm infants

Garcia, Juliana Maia; Gherpelli, José Luiz Dias; Leone, Cléa Rodrigues

doi:10.2223/1203

Cited by 42 publications

(31 citation statements)

References 25 publications

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“…For example, preterm infants without intracranial lesions can exhibit less flexor tone in limbs and increased extensor tone in the neck compared to term infants[40–42]. While sensitive and specific evaluations of movement in infancy such as the Assessment of General Movements can effectively differentiate between the effects of prematurity and other neurologic conditions[43–46], they require access to either highly specialized providers or resources[47–49]. Until further maturation has occurred, it may be difficult for a non-specialized pediatric provider to differentiate increased abnormal tone due to mild CP rather than due to complications of prematurity.…”

Section: Discussionmentioning

confidence: 99%

Early prediction of cerebral palsy after neonatal intensive care using motor development trajectories in infancy

Maitre

Slaughter

Aschner

2013

Early Human Development

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Neonatal intensive care unit (NICU) patients are at high-risk for developmental disabilities such as cerebral palsy (CP). Early identification of CP is essential to effective rehabilitation, but diagnosis is often delayed, especially in preterm infants. We hypothesized longitudinal evaluation of motor trajectories in the NICU Follow-up clinic could distinguish in infancy who developed CP by 3 years of age. Study Design and subjects Retrospective study of 606 patients in the NICU Follow-up clinic at Vanderbilt University with birthweight <1500 g or a diagnosis of hypoxic ischemic encephalopathy. Outcomes measures Assessments included neurologic exams, the Developmental Assessment of Young Children (DAYC), the Bayley Scales of Infant Development (BSID) and the Gross Motor Function Classification Scale. Results A decrease in DAYC scores between 6 and 12 months was present in preterm and term infants later diagnosed with CP, but not in children without CP (−23 vs. +1.5, p <0.001). DAYC score decreases in infancy were highly predictive of later CP (p <0.001). BSID scores quantified severe motor delays but did not add to prediction of CP diagnosis. Conclusion Standardized assessments of motor milestones quantitatively predict the risk of CP in former NICU patients by 12 months, allowing for timely diagnosis, counseling and therapy in high-risk infants.

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Section: Discussionmentioning

confidence: 99%

Early prediction of cerebral palsy after neonatal intensive care using motor development trajectories in infancy

Maitre

Slaughter

Aschner

2013

Early Human Development

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“…The study's outcome assessment was based on a neurological examination and on the Denver developmental screening test, carried out at 12 months. At preterm age the negative predictive value was 100%, but the positive predictive value was only 36% [27]. Spittle et al examined the motor development in 86 preterm infants (likewise by means of AIMS) at 12 months corrected age.…”

Section: Discussionmentioning

confidence: 99%

“…So far, only the study by Garcia and associates from São Paulo confirmed that normal preterm GMs were associated with a normal neurological outcome, whereas abnormal GMs were only predictive when assessed at an age of 3 to 4 months post term [27].…”

Section: Introductionmentioning

confidence: 99%

Is it possible to predict the infant's neurodevelopmental outcome at 14months of age by means of a single preterm assessment of General Movements?

Manacero¹,

Marschik²,

Nunes³

et al. 2012

Early Human Development

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BackgroundIt continues to be a challenge for clinicians to identify preterm infants likely to experience subsequent neurodevelopmental deficits. The Test of Infant Motor Performance (TIMP) and the assessment of spontaneous general movements (GMs) are the only reliable diagnostic and predictive tools for the functionality of the developing nervous system, if applied before term.AimTo determine to what extent singular preterm assessments of motor performance can predict the neurodevelopmental outcome in 14-month olds.MethodsThirty-seven preterm infants born < 34 weeks gestational age were recruited for the study at the NICU of the São Lucas University Hospital, Porto Alegre, RS, Brazil. At 34 weeks, their GMs were assessed; and the Test of Infant Motor Performance (TIMP) was applied. A prospective design was used to examine (A) the association between the GM assessment and the TIMP; and (B) the relation between GMs or the TIMP and the developmental status at 14 months, assessed by means of Alberta Infant Motor Scales (AIMS) and the Pediatric Evaluation of Disability Inventory (PEDI).ResultsNineteen infants (41%) had abnormal GMs; only one scored within the TIMP average range. Hence, GMs and TIMP were not related. Children with cramped-synchronized GMs at 34 weeks preterm had a lower AIMS centile rank than those with poor repertoire or normal GMs. There was a marginal association between cramped-synchronized GMs and a lower PEDI mobility score.ConclusionsA single preterm GM assessment is only fairly to moderately associated with the 14-month motor development. The TIMP is not suitable as a complementary assessment tool at such a young age.

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“…25 More recently, Garcia demonstrated less positive results. 42 In their cohort of 40 preterm infants, 20 minute videotaped observations of gross motor movements varied in accuracy for predicting abnormal neurologic outcome by timing of exam (prior to 37 weeks adjusted age, 37–42 weeks adjusted age, and >42 weeks adjusted age). Sensitivity ranges from 75–100%, specificity from 44–67%, positive predictive value from 36–60% and negative predictive value from 80–100%.…”

Section: Discussionmentioning

confidence: 99%

Neurobehavioral Assessment Predicts Motor Outcome in Preterm Infants

Stephens

Liu

Lester

et al. 2010

The Journal of Pediatrics

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Objective To determine whether Neonatal Intensive Care Unit Network Neurobehavior Scales (NNNS) at 44 weeks predict motor outcome at 2 years in preterm infants from the Maternal Lifestyles Study (MLS). Study design Data were collected on all preterm infants (<36 weeks) in the MLS who had an NNNS at 44 weeks (n=395) and neurologic exam at 12–36 months or Bayley Psychomotor Development Index (PDI) at 24 months (n=270). Logistic regression analyzed NNNS summary scores associated with Cerebral Palsy (CP) or PDI <70, while controlling for birth weight 1250g. Results Eighteen of 395 infants (5%) had CP; 24 of 270 infants (9%) had PDI <70. CP was associated with low quality of movement (OR 1.95, 95% CI 1.24–3.06, p=0.004) and high lethargy (OR 1.67, 95% CI 1.01–2.76, p=0.045). The model contributed 19% of the variance in CP diagnosis at 12–36 months (R2=0.19, p<0.001). Low PDI was associated with low handling (OR 1.83; 95% CI 1.12–2.99, p=0.017), low quality of movement (OR 2.16; 95%CI 1.38–3.38, p=0.001), and hypotonia (OR 1.63; 95% CI 1.14–2.32, p=0.007). The model contributed 26% of the variance in PDI <70 at 24 months (R2=0.26, p<0.001). Conclusions The neurobehavioral profile of underarousal in 44 week preterm infants may predict poor motor outcome.

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The role of spontaneous general movement assessment in the neurological outcome of cerebral lesions in preterm infants

Abstract: When concurrently used, these evaluation methods may increase the specificity and sensitivity in detecting the group of preterm infants at high risk for neurological disturbances in long-term follow-up.

Cited by 42 publications

References 25 publications

Early prediction of cerebral palsy after neonatal intensive care using motor development trajectories in infancy

Early prediction of cerebral palsy after neonatal intensive care using motor development trajectories in infancy

Is it possible to predict the infant's neurodevelopmental outcome at 14months of age by means of a single preterm assessment of General Movements?

Neurobehavioral Assessment Predicts Motor Outcome in Preterm Infants

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