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Predictive value of General Movement Assessment for preterm infants' development at 2 years - implementation in
Freia De Bock1, Heike Will2, Ulrike Behrenbeck2
1Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Ludolf-Krehl Strasse 7-11, 68167 Mannheim, Germany; Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany.
Insights
General movements assessment (GMA) is effective in non-academic settings for predicting neurodevelopmental outcomes in preterm infants. This method accurately identifies risks, ensuring timely interventions for better developmental trajectories.
Area of Science:
- Developmental Pediatrics
- Neuroscience
- Clinical Implementation Science
Background:
- General movements (GM) are established predictors of developmental outcomes in academic settings for preterm infants.
- Limited data exists on the implementation and predictive utility of GM assessment (GMA) in non-academic clinical environments.
Purpose of the Study:
- To document the implementation process of GMA in a non-academic outpatient clinic.
- To evaluate the predictive value of GMA for neurodevelopmental outcomes in preterm infants.
Main Methods:
- GMA was implemented and assessed in 122 infants born before 33 weeks' gestation.
- Predictive value was determined at 1 and 3 months corrected age for motor and cognitive development at 2 years using Bayley Scales and neurological examination.
- Clinical routine scenario analysis considered all available GM data.
Main Results:
- GMA implementation tips are provided.
- Definitely abnormal GM predicted atypical two-year outcomes (OR 13.2), with 55.6% sensitivity and 82.1% specificity.
- Abnormal GM correlated with reduced mental developmental index (MDI) and identified all cerebral palsy cases at 3 months.
Conclusions:
- GMA is successfully implementable in non-academic outpatient settings.
- GMA provides adequate prediction of neurodevelopmental outcomes in preterm infants within a clinical routine scenario.
- The study allays concerns regarding the diagnostic accuracy of GMA in non-academic settings.
Background:
General movements (GM) are used in academic settings to predict developmental outcome in infants born preterm. However, little is known about the implementation and predictive value of GM in non-academic settings.
Aims:
The aim of this study is twofold: To document the implementation of GM assessment (GMA) in a non-academic setting and to assess its predictive value in infants born preterm.
Methods And Procedures:
We documented the process of implementing GMA in a non-academic outpatient clinic. In addition, we assessed the predictive value of GMA at 1 and 3 months' corrected age for motor and cognitive development at 2 years in 122 children born <33 weeks' gestation. Outcome at two years was based upon the Bayley Scales of Infant Development-II (mental/psychomotor developmental index (MDI, PDI)) and a neurological examination. The infants' odds of atypical outcome (MDI or PDI ≤70 or diagnosis CP) and the predictive accuracy of abnormal GMA were calculated in a clinical routine scenario, which used all available GM information (primarily at 3 months or at 1 month, when 3 months were not available). In addition, separate analysis was undertaken for the samples of GMA at 1 and 3 months.
Outcomes And Results:
Tips to facilitate GMA implementation are described. In our clinical routine scenario, children with definitely abnormal GM were more likely to have an atypical two-year outcome than children with normal GM (OR 13.2 (95% CI 1.56; 112.5); sensitivity 55.6%, specificity 82.1%). Definitely abnormal GM were associated with reduced MDI (-12.0, 95% CI -23.2; -0.87) and identified all children with cerebral palsy (CP) in the sample of GMA at 3 months only.
Conclusions And Implications:
GMA can be successfully implemented in a non-academic outpatient setting. In our clinical routine scenario, GMA allowed for adequate prediction of neurodevelopment in infants born preterm, thereby allaying concerns about diagnostic accuracy in non-academic settings.
