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Published on: November 21, 2013
Quality of general movements is related to white matter pathology in very preterm infants
Alicia J Spittle1, Nisha C Brown, Lex W Doyle
1Victorian Infant Brain Studies, Murdoch Childrens Research Institute, 2nd Floor, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Australia 3052. alicia.spittle@rch.org.au
Insights
Abnormal general movements in very preterm infants are linked to white matter abnormalities detected by MRI. This finding suggests that these movement issues reflect white matter injury in early development.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Radiology
Background:
- Preterm infants face heightened risks for neurodevelopmental issues.
- Abnormal general movements in preterm infants are indicators of poor neurodevelopmental outcomes.
- The specific brain lesions causing these abnormal movements in preterm infants are not well understood.
Purpose of the Study:
- To investigate the association between MRI-identified cerebral abnormalities and general movements in very preterm infants.
- To determine if white matter or gray matter pathology correlates with general movement patterns.
- To examine these relationships at 1 and 3 months corrected age.
Main Methods:
- Prospective recruitment of 86 preterm infants (gestational age <30 weeks).
- Brain MRI performed at term-equivalent age to assess white and gray matter pathology.
- Standardized general movement recordings at 1 and 3 months corrected age, scored blindly to MRI findings.
Main Results:
- At 1 month corrected age, 62% of infants exhibited abnormal general movements (poor repertoire or cramped synchronized).
- At 3 months corrected age, 25% of infants had absent fidgety movements.
- Consistent abnormalities in general movements at both 1 and 3 months correlated significantly with increasing white matter abnormalities on MRI, but not gray matter abnormalities.
Conclusions:
- The study supports the hypothesis that abnormal general movements in very preterm infants are indicative of underlying white matter injury.
- MRI-detected white matter abnormalities are significantly associated with general movement patterns at 1 and 3 months corrected age.
- These findings highlight the utility of general movements as a non-invasive marker for white matter injury in preterm infants.
Objective:
Preterm infants are at an increased risk for abnormalities of general movements, which predict subsequent poor neurodevelopmental outcome. The cerebral lesion that predisposes the preterm infant to abnormal general movements remains unknown. The objective of this study was to determine the association between MRI-defined cerebral abnormalities and general movements at 1 and 3 months' corrected age in infants who were born very preterm.
Methods:
Eighty-six preterm infants (<30 weeks' gestation) were prospectively recruited and underwent brain MRI at term-equivalent age to investigate the relationship between qualitative white and gray matter pathology and abnormality of general movements. Standardized videotaped recordings of general movements were obtained at 1 and 3 months postterm (+/-1 week) and scored without knowledge of the MRI findings. At 1 month corrected age, general movements of a writhing character were classified as normal or abnormal (poor repertoire, cramped synchronized, or chaotic). At 3 months' corrected age, fidgety general movements were classified as present or absent.
Results:
At 1 month, 53 (62%) infants had abnormal general movements, 46 of whom had poor repertoire general movements and 7 of whom had cramped synchronized general movements. At 3 months, 23 (25%) infants had absent fidgety movements. At both 1 and 3 months of age, consistently abnormal general movement classifications were related to increasing white matter abnormality on MRI. In contrast, there were no significant relationships between general movement classifications and gray matter abnormalities, either individually or in total.
Conclusion:
The significant relationships between general movements at 1 and 3 months and cerebral white matter abnormalities on MRI in the very preterm infant support the concept that abnormal general movements reflect white matter injury.
