Early neurologic assessment in preterm-infants: Integration of traditional neurologic examination and observation of general movements

Romeo, Domenico M.; Guzzetta, Andrea; Scoto, Mariacristina; Cioni, Matteo; Patusi, Pietro; Mazzone, D; Romeo, Mario

doi:10.1016/j.ejpn.2007.07.008

Cited by 100 publications

(42 citation statements)

References 29 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 best known methods are the Dubowitz assessment for neonates (79) and its adaptation for older infants, the Hammersmith infant neurological examination [HINE (80)], the Prechtl assessment for newborns (65) and its adaptation for older infants, the Touwen infant neurological examination [TINE (75, 81)], and the assessment according to Amiel-Tison (82). Predictive validity of these assessments is generally good (82), with an estimated sensitivity and specificity for CP of 88–92%, respectively (77).…”

Section: Early Diagnostics In Cpmentioning

confidence: 99%

Early Diagnosis and Early Intervention in Cerebral Palsy

2014

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This paper reviews the opportunities and challenges for early diagnosis and early intervention in cerebral palsy (CP). CP describes a group of disorders of the development of movement and posture, causing activity limitation that is attributed to disturbances that occurred in the fetal or infant brain. Therefore, the paper starts with a summary of relevant information from developmental neuroscience. Most lesions underlying CP occur in the second half of gestation, when developmental activity in the brain reaches its summit. Variations in timing of the damage not only result in different lesions but also in different neuroplastic reactions and different associated neuropathologies. This turns CP into a heterogeneous entity. This may mean that the best early diagnostics and the best intervention methods may differ for various subgroups of children with CP. Next, the paper addresses possibilities for early diagnosis. It discusses the predictive value of neuromotor and neurological exams, neuroimaging techniques, and neurophysiological assessments. Prediction is best when complementary techniques are used in longitudinal series. Possibilities for early prediction of CP differ for infants admitted to neonatal intensive care and other infants. In the former group, best prediction is achieved with the combination of neuroimaging and the assessment of general movements, in the latter group, best prediction is based on carefully documented milestones and neurological assessment. The last part reviews early intervention in infants developing CP. Most knowledge on early intervention is based on studies in high-risk infants without CP. In these infants, early intervention programs promote cognitive development until preschool age; motor development profits less. The few studies on early intervention in infants developing CP suggest that programs that stimulate all aspects of infant development by means of family coaching are most promising. More research is urgently needed.

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“…A recent review of 15 studies on the predictive value of fidgety movements reported a sensitivity > 91% and a specificity > 81% [18]. The most comprehensive study so far, in which more than 900 children participated, yielded a sensitivity of 98% and a specificity of 94% [19].…”

Section: Introductionmentioning

confidence: 99%

Cerebral palsy in children: Movements and postures during early infancy, dependent on preterm vs. full term birth

Yang

Einspieler

Wei

et al. 2012

Early Human Development

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BackgroundA deviant motor behaviour at age 3 to 5 months is predictive of cerebral palsy (CP). Particular features of the early motor repertoire even proved predictive of the degree of functional limitations as classified on the Gross Motor Function Classification System (GMFCS) in children with CP, born preterm.AimsWe aimed to determine whether an association between the early motor repertoire and the GMFCS also holds true for children born at term.Study designLongitudinal study.Subjects79 infants (60 boys and 19 girls; 47 infants born at term; video recorded for the assessment of movements and posture at age 9 to 20 weeks postterm age) who developed CP.Outcome measuresThe GMFCS was applied at age 2 to 5 years.ResultsMotor optimality at age 3 to 5 months showed a significant correlation with functional mobility and activity limitation as classified on the GMFCS at age 2 to 5 years in both children born at term (Spearman rho = − 0.66, p < 0.001) and born preterm (rho = − 0.37, p < 0.05). Infants born preterm were more likely to show normal movement patterns than infants born at term. A normal posture and an abnormal, jerky (yet not monotonous) movement character resulted in better levels of function and mobility. With the exception of one, none of the infants showed fidgety movements. A cramped-synchronised movement character, repetitive opening and closing of the mouth, and abnormal finger postures characterised children who would show a poor self-mobility later.ConclusionsAssessing the quality of motor performance at 9 to 20 weeks postterm age (irrespective of the gestational age) improves our ability to predict later functional limitations in children with CP.

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Early neurologic assessment in preterm-infants: Integration of traditional neurologic examination and observation of general movements

Cited by 100 publications

References 29 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

Early Diagnosis and Early Intervention in Cerebral Palsy

Cerebral palsy in children: Movements and postures during early infancy, dependent on preterm vs. full term birth

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