Relationship between early infant motor repertoire and neurodevelopment on the hammersmith infant neurological
Carly Luke1, Leeann Mick-Ramsamy2, Arend F Bos3
1Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia; Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
Insights
Culturally-adapted infant screening using the Motor Optimality Score-revised (MOS-R) effectively predicts neurodevelopmental outcomes on the Hammersmith Infant Neurological Examination (HINE). High retention rates were achieved, demonstrating the program
Area of Science:
- Neurodevelopmental Pediatrics
- Developmental Pediatrics
- Public Health Screening Programs
Background:
- Early identification of neurodevelopmental disorders (NDOs) is crucial for timely intervention.
- Culturally sensitive screening programs are needed to improve engagement among diverse populations, particularly Australian First Nations families.
- The infant motor repertoire offers potential as an early indicator of neurodevelopmental trajectories.
Purpose of the Study:
- To implement and evaluate a culturally-adapted screening program for Australian First Nations infants.
- To determine the predictive ability of infant motor repertoire, assessed by the Motor Optimality Score-revised (MOS-R), for early neurodevelopmental outcomes measured by the Hammersmith Infant Neurological Examination (HINE).
- To enhance engagement of Australian First Nations families in neonatal screening processes.
Main Methods:
- A prospective cohort study involving 156 infants with risk factors for adverse neurodevelopmental outcomes (ad-NDOs).
- Infant motor repertoire assessed using MOS-R via video at 11-13 weeks and 14-18 weeks corrected age (CA).
- Neurodevelopment evaluated using HINE at 4-9 months CA, classifying outcomes as 'on track' or high chance of ad-NDO or cerebral palsy (CP).
Main Results:
- High family engagement (91-94%) in the culturally-adapted screening program.
- Lower MOS-R scores at 14-18 weeks CA significantly predicted reduced HINE scores and increased likelihood of CP or ad-NDO.
- The MOS-R sub-category 'observed movement patterns' and a trajectory of improvement (≥2 point increase) were strong predictors of optimal HINE scores and 'on track' development.
Conclusions:
- The culturally-adapted screening program demonstrated high retention and effectiveness in assessing infant neurodevelopment.
- Infant motor repertoire, particularly MOS-R, is a valuable tool for predicting early neurodevelopmental status in vulnerable First Nations infants.
- This approach enhances engagement and provides crucial early insights into the neurodevelopmental trajectory of infants.
Aim:
To implement a culturally-adapted screening program aimed to determine the ability of infant motor repertoire to predict early neurodevelopment on the Hammersmith Infant Neurological Examination (HINE) and improve Australian First Nations families' engagement with neonatal screening.
Methods:
A prospective cohort of 156 infants (55 % male, mean (standard deviation [SD]) gestational age 33.8 (4.6) weeks) with early life risk factors for adverse neurodevelopmental outcomes (ad-NDO) participated in a culturally-adapted screening program. Infant motor repertoire was assessed using Motor Optimality Score-revised (MOS-R), captured over two videos, 11-13+6 weeks (V1; <14 weeks) and 14-18 weeks (V2; ≥14 weeks) corrected age (CA). At 4-9 months CA neurodevelopment was assessed on the HINE and classified according to age-specific cut-off and optimality scores as; developmentally 'on track' or high chance of either adverse neurodevelopmental outcome (ad-NDO) or cerebral palsy (CP).
Results:
Families were highly engaged, 139/148 (94 %) eligible infants completing MOS-R, 136/150 (91 %), HINE and 123 (83 %) both. Lower MOS-R at V2 was associated with reduced HINE scores (β = 1.73, 95 % confidence interval [CI] = 1.03-2.42) and high chance of CP (OR = 2.63, 95%CI = 1.21-5.69) or ad-NDO (OR = 1.38, 95%CI = 1.10-1.74). The MOS-R sub-category 'observed movement patterns' best predicted HINE, infants who score '4' had mean HINE 19.4 points higher than score '1' (95%CI = 12.0-26.9). Receiver-operator curve analyses determined a MOS-R cut-off of <23 was best for identifying mild to severely reduced HINE scores, with diagnostic accuracy 0.69 (sensitivity 0.86, 95%CI 0.76-0.94 and specificity 0.40, 95 % CI 0.25-0.57). A trajectory of improvement on MOS-R (≥2 point increase in MOS-R from 1st to 2nd video) significantly increased odds of scoring optimally on HINE (OR = 5.91, 95%CI 1.16-29.89) and may be a key biomarker of 'on track' development.
Interpretation:
Implementation of a culturally-adapted program using evidence-based assessments demonstrates high retention. Infant motor repertoire is associated with HINE scores and the early neurodevelopmental status of developmentally vulnerable First Nations infants.
