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Predictive value of General Movements Assessment for developmental delay at 18 months in children with complex
Darlene C Huisenga1, Sacha la Bastide-van Gemert2, Andrew H Van Bergen3
1Advocate Children's Hospital, Department of Pediatric Rehabilitation and Development, Oak Lawn, IL, USA; University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.
Insights
The General Movement Assessment (GMA) can predict general developmental delay in infants with complex congenital heart disease (CCHD). Markedly reduced movement complexity at fidgety age is a key indicator for developmental outcomes in these high-risk infants.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Neonatology
Background:
- Infants with complex congenital heart disease (CCHD) face risks of impaired brain growth and developmental issues.
- The General Movement Assessment (GMA) effectively predicts cerebral palsy (CP) in preterm infants.
- The predictive ability of GMA for infants with CCHD is currently unknown.
Purpose of the Study:
- To assess the predictive value of GMA for developmental outcomes at 18 months corrected age (CA) in infants with CCHD.
- To evaluate GMA's ability to predict cerebral palsy (CP) in this population.
- To determine if GMA can predict specific and general developmental delays post-heart surgery.
Main Methods:
- A prospective cohort of 56 infants with CCHD was evaluated using GMA at writhing (0-6 weeks CA) and fidgety (7-17 weeks CA) stages.
- The Bayley Scales of Infant Development were administered at 18 months CA.
- GMA focused on definitely abnormal (DA) GM-complexity and fidgety movements; predictive values for developmental delay were calculated.
Main Results:
- All infants exhibited fidgety movements; no CP diagnoses were made.
- DA GM-complexity at fidgety age showed 71% sensitivity and 90% specificity for predicting general developmental delay at 18 months.
- GMA at writhing age did not predict developmental delay, nor did it enhance predictions made at fidgety age.
Conclusions:
- In infants with CCHD who have fidgety movements, definitely abnormal GM-complexity during the fidgety stage is a significant predictor of general developmental delay.
- GMA, particularly at the fidgety stage, offers valuable insights into neurodevelopmental outcomes for infants with CCHD.
Background:
Infants with complex congenital heart disease are at increased risk of impaired fetal brain growth, brain injury, and developmental impairments. The General Movement Assessment (GMA) is a valid and reliable tool to predict cerebral palsy (CP), especially in preterm infants. Predictive properties of the GMA in infants with complex congenital heart disease (CCHD) are unknown.
Aim:
To evaluate predictive properties of the GMA to predict developmental outcomes, including cerebral palsy (CP), at 18-months corrected age (CA) in children with CCHD undergoing heart surgery in the first month of life.
Methods:
A prospective cohort of 56 infants with CCHD (35 males, 21 females) was assessed with GMA at writhing age (0-6 weeks CA) and fidgety age (7-17 weeks CA) and the Bayley Scales of Infant Development at 18 months. GMA focused on markedly reduced GM-variation and complexity (definitely abnormal (DA) GM-complexity) and fidgety movements. Predictive values of GMA for specific cognitive, language and motor delay (composite scores <85th percentile) and general developmental delay (delay in all domains) were calculated at 18 months.
Results:
At fidgety age, all infants had fidgety movements and no child was diagnosed with CP. DA GM-complexity at fidgety age predicted general developmental delay at 18 months (71 % sensitivity, 90 % specificity), but predicted specific developmental delay less robustly. DA GM-complexity at writhing age did not predict developmental delay, nor did it improve prediction based on DA GM-complexity at fidgety age.
Conclusions:
In infants with CCHD and fidgety movements, DA GM-complexity at fidgety age predicted general developmental delay.
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