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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
"Fidgety-like movements" in infants born extremely preterm and their relation to later neurodevelopmental outcome
M Örtqvist1, A Spittle2, U Ådén3
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
Insights
Fidgety-like movements occurred in 7% of extremely preterm infants. Despite a low rate of cerebral palsy, over half experienced adverse neurodevelopmental outcomes, indicating a need for close monitoring.
Area of Science:
- Neonatal Neurology
- Developmental Pediatrics
- Movement Disorders
Background:
- The prevalence and clinical significance of
- fidgety-like movements
- a variant of spontaneous movements, remain unclear.
- These movements are observed in infants and can be indicative of neurological development.
Purpose of the Study:
- To determine the prevalence of "fidgety-like movements" in extremely preterm (EPT) infants at 3-5 months corrected age (CA).
- To investigate the association between these movements and major cerebral lesions.
- To assess the neurodevelopmental outcomes in EPT infants exhibiting fidgety-like movements.
Main Methods:
- Retrospective analysis of General Movement Assessment data from 402 EPT infants (<28 weeks gestation) across three international cohorts.
- Utilized the Motor Optimality Score-Revised (MOS-R) at 3-5 months CA.
- Neurodevelopmental outcomes were assessed up to 8 years using standardized methods and ICD-10 classification.
Main Results:
- "Fidgety-like movements" were observed in 7% (26/402) of EPT infants (mean GA 25.1 weeks).
- Of the 25 infants with follow-up, 52% experienced adverse neurodevelopmental outcomes, including motor delay (24%), language delay (20%), and ADHD (16%).
- Only one infant (4%) developed cerebral palsy, but 54% had MOS-R scores below the high-risk threshold for neurodevelopmental disorders.
Conclusions:
- The prevalence of "fidgety-like movements" in EPT infants is 7%.
- While severe cerebral palsy is rare in this group, a significant proportion experience other adverse neurodevelopmental outcomes.
- Reduced MOS-R scores in infants with fidgety-like movements underscore the necessity for vigilant follow-up and early intervention.
Background:
A variant of spontaneous movements "fidgety-like movements" has been described, but its prevalence and clinical relevance remain unclear.
Aim:
To describe the prevalence of "fidgety-like movements" at 3-5 months corrected age (CA), its relation to major cerebral lesions, and neurodevelopmental outcome in children born extremely preterm (EPT; <28 weeks gestation).
Method:
A retrospective re-analysis was conducted using three General Movement Assessment datasets, including Motor Optimality Score-Revised (MOS-R) at 3-5 months CA, in 402 infants born EPT from cohorts in the Netherlands, Sweden and Australia. Follow-up age ranged 1-8 years. Neurodevelopmental outcomes were assessed using standardized assessments and ICD-10, and classified as typical or adverse.
Results:
Twenty-six of 402 infants (7%; range 5-8%) (mean gestational age ± SD, 25.1 ± 1.4 weeks; birth weight 780.1 ± 202.1 g) showed "fidgety-like movements". Median (IQR) MOS-R was 22 (21-24). Eighteen (69%) were boys, 18 (69%) had bronchopulmonary dysplasia and two (8%) had severe brain lesions. Follow-up data were available for 25 children (96%): 12 (48%) had typical and 13 (52%) adverse outcomes. Of those with adverse outcomes, most were motor delay (n = 6, 24%), language delay (n = 5, 20%) and ADHD (n = 4, 16%) or combined, with only one case of CP (4%). Fifty-four percent of children had MOS-R < 23 (below cut-off for high risk of NDD).
Conclusion:
The rate of "fidgety-like movements" was 7% in infants born EPT. Only one infant developed CP; however, more than half of infants with "fidgety-like movements" had adverse outcomes and reduced MOS-R scores highlighting need for careful follow-up.
