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Updated: Aug 4, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Early detection of developmental delay in infants born very preterm or with very low birthweight
Rebecca A Caesar1,2, Roslyn N Boyd2, Giovanni Cioni3
1Women's and Children's Service, Sunshine Coast University Hospital (SCUH), Sunshine Coast Hospital and Health Service District (SCHHS), Sunshine Coast, Australia.
Insights
General Movement Assessment (GMA) trajectories, assessing writhing and fidgety movements in early infancy, accurately predict developmental delay in very preterm infants. This offers a reliable biomarker for typical outcomes and neurodevelopmental risks.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Biomarker discovery
Background:
- Infants born very preterm or with very low birthweight are at high risk for developmental delay.
- Early identification of neurodevelopmental outcomes is crucial for timely intervention.
- Existing biomarkers have limitations in predictive accuracy for diverse outcomes.
Purpose of the Study:
- To identify early clinical biomarkers predicting typical outcomes and developmental delay in high-risk infants.
- To evaluate the predictive validity of the General Movement Assessment (GMA) and other clinical tools.
- To establish reliable markers for motor and cognitive development from birth to 16 weeks corrected age.
Main Methods:
- Prospective cohort study of 104 infants born very preterm or with very low birthweight.
- Utilized Premie-Neuro Examination, GMA, Alberta Infant Motor Scale, and Infant Sensory Profile 2.
- Assessed developmental delay at 24 months corrected age using Bayley Scales (Bayley-III) and NSMDA.
Main Results:
- Suboptimal fidgety movements at 16 weeks corrected age showed high predictive accuracy for motor (AUC 0.87) and cognitive (AUC 0.88) delay.
- GMA trajectories combining writhing (4-5 weeks) and fidgety (16 weeks) movements were superior predictors (p=0.01).
- Developmental delay incidence was 6.3%; GMA accurately differentiated typical from delayed outcomes.
Conclusions:
- The General Movement Assessment (GMA) is a valid biomarker for predicting both typical outcomes and developmental delay in high-risk infants.
- GMA trajectories assessing writhing and fidgety movements provide superior predictive accuracy compared to other clinical and demographic factors.
- Early GMA assessment enables accurate differentiation of infants at risk for adverse neurodevelopmental outcomes.
Aim:
This study aimed to identify early clinical biomarkers from birth to 16 weeks corrected age to predict typical outcome and developmental delay in infants born very preterm or with very low birthweight.
Method:
A prospective cohort of infants on the Sunshine Coast, Australia, was assessed using the Premie-Neuro Examination, the General Movement Assessment (GMA), the Alberta Infant Motor Scale, and the Infant Sensory Profile 2. At 24 months corrected age, delay was identified using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and Neurosensory Motor Developmental Assessment (NSMDA).
Results:
One hundred and four infants were recruited; 79 completed outcome assessments (43 females, 36 males; mean gestational age 30 weeks [SD 1 week 6 days], mean birthweight 1346 g [SD 323]). The incidence of developmental delay (motor or cognitive) was 6.3%. Suboptimal quality of fidgety general movements (temporal organization) at 16 weeks corrected age demonstrated the best predictive accuracy (Bayley-III motor: sensitivity 100% [95% confidence interval {CI} 3-100], specificity 75% [95% CI 63-84], area under the curve [AUC] 0.87); Bayley-III cognitive: sensitivity 100% [95% CI 3-100], specificity 75% [95% CI 64-84], AUC 0.88); NSMDA motor: sensitivity 100% [95% CI 40-100], specificity 81% [95% CI 70-90], AUC 0.91 [95% CI 0.86-0.95]). GMA trajectories that combined abnormal writhing general movements at 4 to 5 weeks corrected age with suboptimal quality of fidgety movement at 16 weeks corrected age were strongly predictive of developmental delay, superior to all other clinical tools, and perinatal and demographic variables investigated (p = 0.01, Akaike information criterion method 18.79 [score corrected for small sample size], accounting for 93% of the cumulative weight).
Interpretation:
Only the GMA had sufficient predictive validity to act as a biomarker for both conditions: typical outcome and developmental delay (motor or cognitive). GMA trajectories that assessed both writhing general movements at 4 to 5 weeks corrected age and quality of fidgety movement at 16 weeks corrected age predicted adverse neurodevelopmental outcome, accurately differentiating between infants with typical outcomes and those at increased risk for motor or cognitive delay.
