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Fidgety movements in infants born very preterm: predictive value for cerebral palsy in a clinical multicentre setting
Alexandre N Datta1,2, Mark A Furrer3, Iris Bernhardt4
1Division of Neuropediatrics and Developmental Medicine, University of Basel Children's Hospital, Basel, Switzerland.
Insights
Fidgety movement assessment (FMA) effectively identifies infants at risk for cerebral palsy (CP). Combining FMA with neonatal cerebral ultrasound improves prediction accuracy in clinical settings.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Movement assessment
Background:
- Early detection of developmental abnormalities in very preterm infants is crucial.
- Fidgety movement assessment (FMA) is a tool used to evaluate early motor development.
- Cerebral palsy (CP) is a significant concern in this population.
Purpose of the Study:
- To assess the predictive value of FMA for developmental abnormalities, specifically CP, in very preterm infants.
- To evaluate FMA's effectiveness in a routine clinical setting.
- To determine if combining FMA with cerebral ultrasound enhances CP prediction.
Main Methods:
- A multicentre study included infants born before 32.0 weeks gestational age.
- FMA was performed at 3 months corrected age.
- Neurodevelopment and neurological abnormalities were assessed at 2 years using Bayley Scales and neurological examination; cerebral ultrasound data was also collected.
Main Results:
- Of 535 infants, 19% exhibited atypical fidgety movements (absent or abnormal).
- Absent fidgety movements predicted CP with an odds ratio (OR) of 8.9.
- Combining atypical fidgety movements with major brain lesions on ultrasound yielded an OR of 17.8 for CP prediction.
Conclusions:
- FMA shows good potential for detecting infants at risk of CP.
- Prediction accuracy was lower in a routine clinical setting compared to research settings.
- Integrating FMA with neonatal cerebral ultrasound significantly improves the prediction of CP.
Aim:
This study assessed predictive values of fidgety movement assessment (FMA) in a large sample of infants born very preterm for developmental abnormalities, in particular for cerebral palsy (CP) at 2 years in an everyday clinical setting.
Method:
This is a multicentre study of infants born preterm with gestational age lower than 32.0 weeks. FMA was performed at 3 months corrected age; neurodevelopment (Bayley Scales of Infant Development, 2nd edition) and neurological abnormalities were assessed at 2 years. Predictive values of FMA for the development of CP were calculated and combined with abnormalities at cerebral ultrasound.
Results:
Five hundred and thirty-five infants (gestational age 28.2wks [standard deviation 1.3wks]) were included. Eighty-one percent showed normal fidgety movements and 19% atypical (82 absent, 21 abnormal) fidgety movements. Absent fidgety movements predicted CP at 2 years with an odds ratio (OR) of 8.9 (95% confidence interval [CI] 4.1-17.0), a combination of atypical fidgety movements and major brain lesion on cerebral ultrasound predicted it with an OR of 17.8 (95% CI 5.2-61.6). Mean mental developmental index of infants with absent fidgety movements was significantly lower (p=0.012) than with normal fidgety movements.
Interpretation:
Detection of infants at risk for later CP through FMA was good, but less robust when performed in a routine clinical setting; prediction improved when combined with neonatal cerebral ultrasound.
