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General movement trajectories and neurodevelopment at 3months of age following neonatal surgery
Cathryn Crowle1, Karen Walker2, Claire Galea3
1Grace Centre for Newborn Care, The Children's Hospital Westmead, Sydney, Australia; University of Sydney, Sydney, Australia.
Insights
Neonatal surgery increases neurodevelopmental disability risk. General Movements Assessment (GMA) shows most infants have normal fidgety movements and development at 3 months, despite initial poor repertoire writhing.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Pediatric surgery
Background:
- Major surgery in neonates poses a risk for neurodevelopmental disability.
- General Movements Assessment (GMA) is a validated tool for predicting neurodevelopmental outcomes.
- Limited data exist on GMA's utility in postsurgical infants.
Purpose of the Study:
- To characterize General Movements (GMs) trajectories in infants following neonatal surgery.
- To assess neurodevelopmental outcomes using GMA and Bayley Scales of Infant and Toddler Development III.
Main Methods:
- Prospective cohort study of 217 infants undergoing major cardiac or non-cardiac neonatal surgery.
- GMA and Bayley Scales of Infant and Toddler Development III assessments were performed at term age and 3 months corrected age.
- GMA videos were scored by three trained assessors, with two blinded to infant clinical status.
Main Results:
- 'Poor repertoire' writhing movements were common (54%), but 84% of these infants had normal fidgety movements.
- Only 4 out of 75 infants (34%) with normal writhing had absent fidgety movements.
- Eleven percent (24/217) of infants had absent fidgety movements and demonstrated lower Bayley Scale scores.
Conclusions:
- This study provides the first description of GMA trajectories in postsurgical neonates.
- While many infants exhibit atypical writhing movements, most achieve normal fidgety movements and neurodevelopment at 3 months.
- GMA can identify infants at risk for neurodevelopmental deficits post-surgery, similar to other high-risk populations.
Background:
Neonates who undergo major surgery are at risk of neurodevelopmental disability. The General Movements Assessment (GMA) is a valid and reliable method to predict neurodevelopment, however, there are minimal data on the applicability among infants post-surgery.
Aim:
To describe GMs trajectories following neonatal surgery.
Study Design:
Prospective cohort study.
Subjects:
217 infants following major cardiac and non-cardiac neonatal surgery.
Outcome Measures:
Infants were assessed following surgery at term age (mean 40weeks, SD 2.3), and at 3months of age (mean 12weeks, SD 1.6) using the GMA and the Bayley Scales of Infant and Toddler Development III. GMA videos were independently scored by three advanced trained assessors, two blinded to infant details.
Results:
The most common result in the writhing period was 'poor repertoire' (n=117, 54%), however, 99 (84%) of these infants had normal fidgety movements. For infants with normal writhing (n=75, 34%), only four had absent fidgety movements. Cramped synchronised movements were seen in 10 infants, and three of these were rated as absent fidgety. There was no significant difference between the surgical groups. In total, 24 infants (11%) had absent fidgety movements and lower scores on average in all subtests of the BSID-III than those with normal fidgety movements.
Conclusions:
This is the first report describing GMs trajectories in infants who have undergone neonatal surgery. Similar to other high risk infant populations, this group showed a high proportion of poor repertoire writhing movements, however, most infants demonstrated normal fidgety movements and development at 3months of age.
