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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Preterm and term-equivalent age general movements and 1-year neurodevelopmental outcomes for infants born before
Joy E Olsen1,2,3, Leesa G Allinson1,4, Lex W Doyle1,2,3,5
1Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
Insights
Abnormal General Movements Assessment (GMA) before term predicts neurodevelopmental deficits at 12 months corrected age in very preterm infants. Early GMA can identify infants at risk for developmental issues.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Movement science
Background:
- Prechtl's General Movements Assessment (GMA) is a validated tool for assessing neurological development in infants.
- Very preterm infants are at high risk for neurodevelopmental impairments.
- Early identification of neurodevelopmental risks is crucial for timely intervention.
Purpose of the Study:
- To investigate the association between General Movements Assessment (GMA) performed from birth to term-equivalent age and neurodevelopmental outcomes at 12 months corrected age.
- To determine if abnormal GMA in very preterm infants predicts later neurodevelopmental deficits.
Main Methods:
- A cohort of 137 infants born before 30 weeks' gestation underwent serial GMA (normal or abnormal) before and at term-equivalent age.
- Neurodevelopment at 12 months corrected age was assessed using the Alberta Infant Motor Scale (AIMS), Neurological, Sensory, Motor, Developmental Assessment (NSMDA), and Touwen Infant Neurological Examination (TINE).
- Regression models were used to analyze the relationship between GMA findings and neurodevelopmental outcomes.
Main Results:
- Abnormal GMA at all assessed time points correlated with poorer continuous scores on AIMS, NSMDA, and TINE.
- Abnormal GMA before term and at term-equivalent age were significantly associated with an increased likelihood of mild-to-severe dysfunction on the NSMDA.
- Abnormal GMA before term also predicted a higher risk of suboptimal-to-abnormal motor function on the TINE.
Conclusions:
- Abnormal General Movements Assessment before term and at term-equivalent age are predictive of adverse neurodevelopmental outcomes at 12 months corrected age in very preterm infants.
- GMA performed before term is a valuable screening tool for identifying very preterm infants at risk for developmental deficits.
- These findings underscore the importance of early neuromotor assessment in very preterm populations.
Aim:
To examine the associations between Prechtl's General Movements Assessment (GMA), conducted from birth to term-equivalent age, and neurodevelopmental outcomes at 12 months corrected age, in infants born very preterm.
Method:
One hundred and thirty-seven infants born before 30 weeks' gestation had serial GMA (categorized as 'normal' or 'abnormal') before term and at term-equivalent age. At 12 months corrected age, neurodevelopment was assessed using the Alberta Infant Motor Scale (AIMS); Neurological, Sensory, Motor, Developmental Assessment (NSMDA); and Touwen Infant Neurological Examination (TINE). The relationships between GMA at four time points and 12-month neurodevelopmental assessments were examined using regression models.
Results:
Abnormal GMA at all time points were associated with worse continuous scores on the AIMS, NSMDA, and TINE (p<0.05). Abnormal GMA before term and at term-equivalent age were associated with increased odds of mild-severe dysfunction on the NSMDA (odds ratio [OR] 4.26, 95% confidence interval [CI] 1.55-11.71, p<0.01; and OR 4.16, 95% CI 1.55-11.17, p<0.01 respectively) and abnormal GMA before term with increased odds of suboptimal-abnormal motor function on the TINE (OR 2.75, 95% CI 1.10-6.85, p=0.03).
Interpretation:
Abnormal GMA before term and at term-equivalent age were associated with worse neurodevelopment at 12 months corrected age in children born very preterm.
What This Paper Adds:
Abnormal general movements before term predict developmental deficits at 1 year in infants born very preterm. General Movements Assessment before term identifies at-risk infants born very preterm.
