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High Prevalence of Abnormal General Movements in Hospitalized Very Low Birth Weight Infants
Corrie J Alonzo1, Lisa C Letzkus2, Elizabeth A Connaughton3
1Department of Pediatrics, Division of Neonatology, University of Virginia, Charlottesville, Virginia.
Insights
Abnormal general movements (GMs) are prevalent in very low birth weight (VLBW) infants, with poor repertoire being the most common type. The General Movement Assessment (GMA) can identify VLBW infants at higher risk for motor impairments.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Movement science
Background:
- Abnormal general movements (GMs) in preterm infants are linked to future motor impairments.
- The General Movement Assessment (GMA) is a tool to evaluate these movements.
- Very low birth weight (VLBW) infants are a vulnerable population requiring early risk assessment.
Purpose of the Study:
- To detail the implementation of the GMA in a neonatal intensive care unit (NICU).
- To determine the prevalence and changes in abnormal GMs among VLBW infants.
- To assess the utility of GMA in identifying infants at risk for motor deficits.
Main Methods:
- An observational study was conducted in a level-IV NICU.
- The GMA was applied to VLBW infants (GA <32 weeks and/or BW <1,500 g).
- GMAs were scored weekly by certified providers, with exclusions for infants on high-frequency ventilation or unable to be unbundled.
Main Results:
- 121 VLBW infants were assessed (mean GA 28.3 weeks, mean BW 1,113 g).
- Initially, only 28% had normal GMs; 61% showed poor repertoire and 11% cramped-synchronized GMs.
- At discharge, 45% had poor repertoire and 21% cramped-synchronized GMs, with most initial cramped-synchronized movements persisting.
Conclusions:
- Abnormal GMs, particularly poor repertoire, are common in VLBW infants.
- The GMA is feasible for implementation in the NICU setting for VLBW infants.
- GMA can aid in identifying VLBW infants at risk for motor impairments and stratifying them for interventions.
Objective:
Abnormal general movements (GMs) are predictive of later risk of motor impairments in preterm infants. The goals of this study are to (1) describe the implementation of the GM assessment (GMA) in a neonatal intensive care unit (NICU) and (2) investigate the prevalence and evolution of abnormal GMs in very low birth weight (VLBW) infants.
Study Design:
Observational study of GMs in VLBW infants (gestational age [GA] <32 weeks and/or birth weight [BW] <1,500 g) following GMA implementation in a level-IV NICU. All VLBW infants admitted between November 2017 and April 2019 were eligible for the GMA. Infants were excluded if they required high-frequency ventilation or if they could not be unbundled for video acquisition. GMAs were scored weekly by at least 2 GMA-certified providers.
Results:
The GMA was performed in 121 VLBW infants with a mean (standard deviation [SD]) GA of 28.3 (2.6) and BW of 1,113 (400 g). Only 28% of infants had normal GMs on initial assessment (32.9 ± 2.7 weeks' GA), while 61 and 11% had poor repertoire and cramped-synchronized GMs, respectively. At NICU discharge (37.6 ± 3.4 weeks corrected GA), 45 and 21% of infants were classified as having poor repertoire and cramped-synchronized GMs, respectively. Most infants with cramped-synchronized GMs on initial assessment had persistent abnormal GMs at discharge. In contrast, only one infant with normal GMs on first assessment developed cramped-synchronized GMs.
Conclusion:
Abnormal GMs are common in VLBW infants, including a high prevalence of the more concerning cramped-synchronized movement pattern. The GMA can be successfully performed in VLBW infants. The GMA may be helpful in identifying infants at increased risk of later motor impairments, as well as assisting clinicians, in the stratification of infants who may benefit from additional brain imaging and/or an intensive hospital-based interventions.
Key Points:
· Abnormal GMs are common in VLBW infants.. · Poor repertoire in the most prevalent pattern observed.. · Infants at risk for abnormal motor outcomes can be identified in the NICU..
