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PREDICTIVE VALUE OF THE GENERAL MOVEMENTS ASSESSMENT IN PRETERM INFANTS: A META-ANALYSIS
Camila da Silva Pires1, Sérgio Tadeu Martins Marba1, Jamil Pedro de Siqueira Caldas1
1Universidade Estadual de Campinas, Campinas, SP, Brazil.
Insights
The General Movements Assessment effectively predicts neurodevelopmental disorders in preterm infants. Fidgety Movements show the strongest predictive validity for cerebral palsy, though more research is needed.
Area of Science:
- Neurology
- Developmental Pediatrics
- Diagnostic Accuracy
Background:
- Preterm newborns are at increased risk for neurodevelopmental disorders.
- Early detection and diagnosis are crucial for timely intervention.
- The General Movements Assessment (GMA) is a non-invasive tool for assessing neurological status.
Purpose of the Study:
- To evaluate the predictive value of the General Movements Assessment (GMA) for diagnosing neurodevelopmental disorders in preterm infants.
- To synthesize evidence on the diagnostic accuracy of GMA components, specifically Writhing Movements and Fidgety Movements.
- To identify the predictive validity of GMA for cerebral palsy in this population.
Main Methods:
- A systematic literature review was performed across major databases (SciELO, PubMed, EMBASE).
- Studies were selected based on specific criteria including population, GMA use, and predictive variables.
- Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool; diagnostic accuracy metrics were calculated.
Main Results:
- Six studies were included, analyzing 342 articles.
- Writhing Movements demonstrated good sensitivity and accuracy for recognizing cerebral palsy.
- Fidgety Movements exhibited the strongest predictive validity for cerebral palsy, with high diagnostic accuracy across all measures.
- Quality assessment revealed a high risk of bias in patient selection and study conduct.
Conclusions:
- The General Movements Assessment shows significant potential for detecting neurodevelopmental disorders in preterm infants.
- Fidgety Movements, in particular, possess strong predictive validity for cerebral palsy.
- Further research is warranted due to heterogeneity in existing studies and identified limitations.
Objective:
To discuss the predictive value of the General Movements Assessment for the diagnosis of neurodevelopment disorders in preterm newborns.
Data Source:
We conducted a systematic literature review using the following databases: Scientific Electronic Library Online (SciELO), National Library of Medicine, National Institutes of Health (PubMed), and Excerpta Medica Database (EMBASE). The articles were filtered by language, year of publication, population of interest, use of Prechtl's Method on the Qualitative Assessment of General Movements, and presence of variables related to the predictive value. The Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess the methodology of the included studies. Sensitivity, specificity, Diagnostic Odds Ratio, positive and negative likelihood ratio, and parameter of accuracy were calculated.
Data Synthesis:
Six of 342 articles were included. The evaluation of Writhing Movements is a good indicator for recognizing cerebral palsy, as it has high values for the sensitivity and accuracy parameters. The evaluation of Fidgety Movements has the strongest predictive validity for cerebral palsy, as it has high values in all measures of diagnostic accuracy. The quality assessment shows high risk of bias for patient selection and flow and timing of the evaluation. Therefore, the scale has potential to detect individuals with neurodevelopment disorders. However, the studies presented limitations regarding the selection of subjects and the assessment of neurological outcomes.
Conclusions:
Despite the high predictive values of the tool to identify neurological disorders, research on the subject is required due to the heterogeneity of the current studies.
