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Qualitative changes of general movements in preterm infants with brain lesions
F Ferrari1, G Cioni, H F Prechtl
1Institute of Paediatrics and Neonatal Medicine, University of Modena, Italy.
Insights
Qualitative assessment of general movements in preterm infants reliably detects nervous system impairment. This non-intrusive method predicts neurological outcomes better than brain imaging for high-risk infants.
Area of Science:
- Neonatology
- Neurodevelopmental Pediatrics
- Movement Science
Background:
- Preterm infants are at higher risk for neurological impairments.
- Early detection of functional nervous system impairment is crucial for timely intervention.
- Previous studies quantitatively assessed motor activity, but qualitative analysis of general movements was less explored.
Purpose of the Study:
- To replicate quantitative motor activity studies in low-risk and high-risk preterm infants.
- To apply a novel method for systematic qualitative analysis of general movements.
- To correlate movement patterns with neurological outcomes up to three years corrected age.
Main Methods:
- Sequential one-hour videorecordings of unstimulated preterm infants in incubators.
- High-risk group defined by brain hemorrhage/leucomalacia on ultrasonography.
- Neurological follow-up to a minimum of one and maximum of three years corrected age.
- Quantitative analysis of motor patterns and qualitative assessment of general movements.
Main Results:
- A slight, significant excess of isolated arm movements in low-risk infants (P=0.05).
- All high-risk infants (N=29) exhibited abnormal general movement quality during the preterm period.
- Nineteen high-risk infants developed cerebral palsy; strabismus was present in 48.3%.
Conclusions:
- Qualitative assessment of general movements is a reliable, non-intrusive method for early detection of nervous system impairment in neonates.
- The developmental trajectory of abnormal general movements predicts neurological outcome more effectively than imaging findings.
- This method offers a quick and cost-effective approach to neonatal neurodevelopmental screening.
Abstract:
The aims of the study were (1) to replicate previous quantitative studies of motor activity in low-risk and high-risk preterm infants and (2) to apply a new method of systematic analysis of the qualitative characteristics of general movements in these two groups of infants. Sequential one-hour videorecordings of the unstimulated infants in the incubator were made during the preterm period and then continued during the postterm period until about 20 weeks. The high-risk group consisted only of infants with signs of haemorrhage and/or leucomalacia in the repeated ultrasonograms of the brain. The neurological follow-up continued up to a minimum of one and a maximum of three years of corrected age. The quantification of the various motor patterns in 12 matched pairs of low-risk and high-risk preterm infants revealed a slight but significant (P = 0.05) excess of isolated arm movements in the low-risk cases during the activity phase. No other movement pattern differed significantly. The qualitative assessment of general movements during the preterm period resulted in all but one of the 14 low-risk cases having a normal quality of general movements. In the lesion-group (N = 29) all the infants had an abnormal quality during the preterm period. Eight cases later became neurologically normal although 1 of them had strabism. In addition, one infant was blind (ROP) and retarded and one other had mental retardation. Nineteen infants later developed cerebral palsy (two monoplegia of a leg, three hemiplegia, 5 diplegia and 9 quadriplegia). Strabism was present in 48.3% of the whole group of 29 cases. A semi-quantitative estimation of various aspects of the abnormal general movements made a typology of abnormal patterns possible. A graphic display of developmental trajectories of individual cases, depicting the course of abnormal aspects along the time axis, helps document the evolution of abnormal signs. Their course is a better predictor of the neurological outcome than the nature and localization of the lesion, detected by imaging techniques. The qualitative assessment of general movements from videorecordings is a reliable, quick, cheap and totally non-intrusive method in neonatology for the early detection of functional impairment of the nervous system.