Early detection of developmental delay in infants born very preterm or with very low birthweight

Abstract

Aim: This study aimed to identify early clinical biomarkers from birth to 16 weeks corrected age to predict typical outcome and developmental delay in infants born very preterm or with very low birthweight. Method:A prospective cohort of infants on the Sunshine Coast, Australia, was assessed using the Premie-Neuro Examination, the General Movement Assessment (GMA), the Alberta Infant Motor Scale, and the Infant Sensory Profile 2. At 24 months corrected age, delay was identified using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and Neurosensory Motor Developmental Assessment (NSMDA).Results: One hundred and four infants were recruited; 79 completed outcome assessments (43 females, 36 males; mean gestational age 30 weeks [SD 1 week 6 days], mean birthweight 1346 g [SD 323]). The incidence of developmental delay (motor or cognitive) was 6.3%. Suboptimal quality of fidgety general movements (temporal organization) at 16 weeks corrected age demonstrated the best predictive accuracy

How well does the General Movement Assessment predict general developmental delay in infants born very preterm/low birthweight?

“…Consistent with this line of research, Caesar et al reported that the suboptimal quality of general movements (especially fidgety general movements at 16 weeks corrected age) had predictive accuracy of motor and cognitive delay at 2 years with high sensitivity in infants born very preterm/low birthweight 2 . Furthermore, the authors suggest that GMA trajectories that combined abnormal writhing general movements with the suboptimal fidgety movements are strong behavioral markers for predicting developmental delay.…”

“…First, the prediction of cognitive function through the GMA is still less accurate overall than that of cerebral palsy, and inconsistent across previous studies 1,2 . This lesser accuracy is assumed to reflect the diversity of cognitive dysfunctions and their etiologies, in addition to the lack of studies examining the relationship to general movements.…”

Reduction in limb-movement complexity at term-equivalent age is associated with motor developmental delay in very-preterm or very-low-birth-weight infants

“…This study adopted writhing movements at term-equivalent age as the analysis target of importance because the complexity is strongly associated with MDD 2 , 4 , 27 . Infantile spontaneous movements may show spatiotemporal characteristics analogous to spontaneous activity in the neocortex of the developing brain (e.g.…”

“…The early detection of high-risk infants for neurologic impairment is crucial for timely intervention. The identification of risk factors in preterm or low birth weight infants during the neonatal period facilitates early detection, leading to the initiation of early intervention and consequently, improving neurodevelopmental outcomes 1 , 2 . The General Movement Assessment (GMA), which was developed by Prechtl et al on infantile spontaneous movements, is recognized as a reliable and valid method for the early detection of high-risk infants 3 – 5 .…”

“…The General Movement Assessment (GMA), which was developed by Prechtl et al on infantile spontaneous movements, is recognized as a reliable and valid method for the early detection of high-risk infants 3 – 5 . It can evaluate writhing and fidgety movements in infants from birth to 5 months of corrected age with high sensitivity and specificity to predict developmental delay and cerebral palsy 2 , 6 – 8 . Despite its high-level evidence in clinical practice, its clinical availability can be limited due to a high dependence on certified assessors who are educated through training courses along with its subjective nature as a qualitative or semi-quantitative assessment 4 , 9 , 10 .…”