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General movements in very preterm children and neurodevelopment at 2 and 4 years
Alicia J Spittle1, Megan M Spencer-Smith, Jeanie L Y Cheong
1Victorian Infant Brain Study, Murdoch Childrens Research Institute, Melbourne, Australia. alicia.spittle@mcri.edu.au
Insights
Abnormal general movements (GM) in very preterm infants at 1 and 3 months corrected age predict later neurodevelopmental issues. Assessment at 3 months offers better accuracy for identifying children with impairments.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Movement analysis
Background:
- Very preterm (VP) infants face high rates of neurodevelopmental impairments.
- Early prediction of these impairments is crucial for timely intervention.
- General movements (GM) offer a potential window for early assessment.
Purpose of the Study:
- To evaluate the predictive value of general movements (GM) at 1 and 3 months corrected age.
- To assess neurodevelopmental outcomes at 2 and 4 years in very preterm infants.
- To determine the optimal timing for GM assessment in this population.
Main Methods:
- General movements (GM) were assessed as normal or abnormal at 1 and 3 months corrected age in infants born <30 weeks gestation.
- Neurodevelopment was evaluated at 2 years using Bayley Scales (3rd Ed.).
- Cognitive, language, and motor outcomes were assessed at 4 years, along with cerebral palsy diagnosis.
Main Results:
- Abnormal GM at 1 month predicted poorer motor outcomes at 2 and 4 years.
- Abnormal GM at 3 months predicted worse motor, cognitive, and language outcomes at both ages.
- GM at 3 months showed better specificity and overall accuracy in predicting impairments.
Conclusions:
- Abnormal general movements in very preterm infants are predictive of neurodevelopmental deficits.
- GM assessment at 3 months corrected age is a valuable tool for identifying infants at risk.
- This assessment aids in early detection and intervention planning for VP infants.
Objective:
Although ~50% of very preterm (VP) children have neurodevelopmental impairments, early prediction of infants who will experience problems later in life remains a challenge. This study evaluated the predictive value of general movements (GM; spontaneous and endogenous movements) at 1 and 3 months' corrected age for neurodevelopment at 2 and 4 years of age in VP children.
Methods:
At 1 and 3 months' corrected age, infants born <30 weeks' gestation had GM assessed as normal or abnormal. Motor, cognitive, and language development at 2 years was assessed by using the Bayley Scales of Infant and Toddler Development, Third Edition. At 4 years, cognitive and language outcomes were assessed by using the Differential Ability Scale-Second Edition and motor outcomes with the Movement Assessment Battery for Children-Second Edition; a diagnosis of cerebral palsy was documented.
Results:
Ninety-nine VP infants were recruited, with 97% and 88% of survivors followed up at age 2 and 4 years, respectively. Abnormal GM at 1 month were associated with worse motor outcomes at 2 and 4 years but not language or cognitive outcomes. Abnormal GM at 3 months were associated with worse motor, cognitive, and language outcomes at both 2 and 4 years. Overall, GM at 1 month demonstrated better sensitivity to impairments at 2 and 4 years, whereas GM at 3 months had better specificity and were more accurate overall at distinguishing between children with and without impairment.
Conclusions:
Abnormal GM in VP infants, particularly at 3 months postterm, are predictive of worse neurodevelopment at ages 2 and 4 years.
