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General Movements as Predictive Tool of Neurological Outcomes in Term-Born Infants With Hypoxic-Ischemic
Rudresh Naik1, Lokesh Saini2, Christa Einspieler3
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
General movements assessment, specifically absent fidgety movements (FMs), accurately predicts neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy (HIE). Absent FMs strongly correlate with cerebral palsy and developmental delays, aiding early intervention.
Area of Science:
- Neonatal Neurology
- Developmental Pediatrics
- Neurorehabilitation
Background:
- Hypoxic-ischemic encephalopathy (HIE) poses significant risks for neurodevelopmental outcomes in term-born infants.
- Early identification of neurological impairment is crucial for timely intervention and improved prognosis.
Purpose of the Study:
- To evaluate the predictive utility of general movements (GMs) assessment, focusing on fidgety movements (FMs), for neurological outcomes in infants with HIE.
- To assess the correlation between GM assessment findings and later developmental assessments at 6 and 12 months of age.
Main Methods:
- Prospective observational study involving term-born newborns diagnosed with HIE.
- General movements videos were recorded and assessed at 10-14 weeks postmenstrual age.
- Neurodevelopmental outcomes were evaluated using the Developmental Assessment Scales for Indian Infants (DASII) and Ages and Stages Questionnaire, third edition (ASQ-3) at 6 and 12 months.
Main Results:
- Of 30 infants, 19 had normal FMs and 11 had absent FMs.
- Infants with absent FMs showed a high incidence of moderate to severe developmental delay (DD) on DASII (P < 0.001).
- Absent FMs demonstrated 81.8% sensitivity and 89.4% specificity for detecting cerebral palsy (CP).
Conclusions:
- General movements assessment, particularly the presence or absence of FMs, is a highly predictive tool for neurodevelopmental outcomes in HIE infants.
- Absent FMs are strongly associated with cerebral palsy and significant developmental delays.
- The Motor Optimality Score, Revised (MOS-R), can offer a fair estimation of functional ability in infants who develop CP.
Background:
To explore the utility of general movements assessment as a predictive tool of the neurological outcome in term-born infants with hypoxic-ischemic encephalopathy (HIE) at ages six and 12 months.
Methods:
This prospective observational study was conducted for 18 months (August 2018 to December 2019). Term-born newborns with HIE were included. General movements videos were recorded at 10 to 14 weeks (50 to 54 weeks postmenstrual age) and assessed. Further development was assessed with Developmental Assessment Scales for Indian Infants (DASII) and Ages and Stages Questionnaire, third edition, (ASQ-3) at ages six and 12 months.
Results:
A total of 30 children were enrolled, 19 (63%) had normal fidgety movements (FMs) and 11 (37%) had absent FMs. Motor Optimality Score, Revised, (MOS-R) ranged from 6 to 8 in 11 infants with absent FMs. Among them, one had mild developmental delay (DD), two had moderate DD, and eight had severe DD on the DASII assessments (P < 0.001). Sensitivity between absent FMs and ASQ-3 developmental scales showed that the majority with absent FMs had severe DD. Absent FMs had 81.8% sensitivity and 89.4% specificity for detecting cerebral palsy (CP) (n = 11).
Conclusions:
The assessment of the FMs has a very good predictive value for future neurodevelopmental outcomes. MOS-R can provide a fair estimate of the functional ability of infants who later develop CP, and better MOS-R scores correlate with better outcomes. Children with absent FMs had significantly lower median motor and mental developmental quotients as calculated by DASII at both ages six and 12 months.
