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Published on: August 25, 2014
Early prediction of neurodevelopmental outcomes at 12 years in children born extremely preterm
Maria Örtqvist1, Christa Einspieler2, Ulrika Ådén3
1Neonatal Research Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden. maria.ortqvist@ki.se.
Insights
General Movement Assessment (GMA) and Motor Optimality Score-Revised (MOS-R) at 3 months corrected age accurately predict adverse neurodevelopmental outcomes at 12 years in extremely preterm infants.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Movement Science
Background:
- Extremely preterm (EPT) birth is a significant risk factor for neurodevelopmental impairments.
- Early identification of potential long-term neurodevelopmental issues is crucial for timely intervention.
Purpose of the Study:
- To evaluate the predictive value of Prechtl General Movement Assessment (GMA), including the Motor Optimality Score-Revised (MOS-R), at 3 months corrected age (CA).
- To assess the prediction of adverse neurodevelopmental outcomes at 12 years of age in EPT infants.
Main Methods:
- GMA and MOS-R were administered at 3 months CA to 53 EPT infants (mean GA 25 weeks).
- Neurodevelopmental outcomes were assessed at 12 years using Touwen's neurological examination, Movement Assessment Battery for Children-2, and chart reviews.
- Statistical analysis compared outcomes between groups and calculated predictive values.
Main Results:
- Of 42 children followed up, 62% had adverse neurodevelopmental outcomes.
- The MOS-R scores differed significantly between outcome groups (p=0.007).
- GMA and MOS-R demonstrated high positive predictive values (1.00 and 0.77, respectively) and specificity (1.00 and 0.77) for adverse outcomes.
Conclusions:
- Prechtl GMA, including MOS-R, effectively predicts overall adverse neurodevelopment at 12 years in EPT children.
- Aberrant general movements with a MOS < 21 at 3 months CA indicates increased risk for adverse neurodevelopment.
- GMA with MOS-R is recommended as a key component of neurological assessment for EPT infants at 3 months CA.
Background:
Extremely preterm (EPT) birth is a major risk factor for neurodevelopmental impairments. The aim was to evaluate the predictive value of Prechtl General Movement Assessment (GMA), including the Motor Optimality Score-Revised (MOS-R), at 3 months corrected age (CA) for adverse neurodevelopmental outcome at the age of 12 years.
Methods:
The GMA, including the MOS-R, was applied at 3 months CA and outcomes were assessed at 12 years by Touwen's neurological examination, the Movement Assessment Battery for Children-2, and chart reviews.
Results:
Fifty-three infants born EPT (33 boys, mean GA 25 weeks, mean body weight 805 ± 156 g) were included. Forty-two (79%) children participated in the follow-up (mean age 12.3 ± 0.4) and 62% of these had adverse outcomes. The MOS-R differed between groups (p = 0.007). The respective predictive values of GMA, aberrant FMs, and the MOS-R cut-off of 21 for adverse outcomes were positive predictive values (PPVs) of 1.00 and 0.77, negative predictive value of 0.47 and 0.63, sensitivity of 0.31 and 0.77, and specificity of 1.00 and 0.77.
Conclusions:
Using the Prechtl GMA, including the MOS-R, at 3 months CA predicted an overall adverse neurodevelopment at 12 years, with a high PPV, specificity, and sensitivity in children born EPT.
Impact:
The Prechtl GMA, including the MOS-R, can improve early identification of long-term adverse neurodevelopmental outcomes. This is the first study to investigate the predictive value of the MOS-R for neurodevelopmental outcome at mid-school age in children born EPT. Using the GMA, including the MOS-R, is suggested as one important part of the neurological assessment at 3 months CA in children born EPT. Aberrant FMs in combination with a MOS of <21 is an indicator of an increased risk of future adverse neurodevelopment in children born EPT.
