Elsevier

The Lancet

Volume 349, Issue 9062, 10 May 1997, Pages 1361-1363
The Lancet

Early Report
An early marker for neurological deficits after perinatal brain lesions

https://doi.org/10.1016/S0140-6736(96)10182-3Get rights and content

Summary

Background

In normal awake infants, fidgety movements are seen from the age of 6 weeks to 20 weeks. The aim of the study was to test the predictive value of absent or abnormal spontaneous movements in young infants for the later development of neurological deficits.

Methods

In a collaborative study involving five hospitals we collected data on the normal and abnormal quality of fidgety movements of 130 infants and compared it with assessments of neurological development done longitudinally until the age of 2 years. On the basis of ultrasound scans infants were classified as at low-risk or at high-risk of neurological deficits. Infants were videoed for 1 h every week from birth to discharge and then for 15 min every 3 to 4 weeks; quality of general movements was assessed. Repeated neurological assessments were also done until 24 months of corrected age.

Findings

67 (96%) of 70 infants with normal fidgety movements had a normal neurological outcome. Abnormal quality or total absence of fidgety movements was followed by neurological abnormalities in 57 (95%) of the 60 infants (49 had cerebral palsy and eight had developmental retardation or minor neurological signs). Specificity and sensitivity of fidgety movement assessment were higher (96% and 95%, respectively) than of ultrasound imaging of the infants' brain (83% and 80%, respectively).

Interpretation

Our technique of assessing spontaneous motor activity can identify and distinguish between those infants who require early intervention for neurological abnormalities and those who do not. Our technique is simple, non-intrusive, reliable, quick, and can be done on very young infants.

Introduction

The human fetus and young infant have a repertoire of distinct movement patterns that are spontaneous.1 One set of these movement patterns are known as general movements.2 These movements can be observed in fetuses as young as 10 weeks postmenstrual age.3 Postmenstrual age, age of the fetus or infant calculated from the date of the mother's last period, is used as a way of compensating for premature birth. In infants at low-risk of neurological damage general movements continue in a similar pattern until about the end of the second month post term.4

After birth, general movements are commonly referred to as writhing movements.4 At the age of 6 to 9 weeks post term the form and character of general movements of normal infants changes from the writhing type into a fidgety pattern.4, 5 Fidgety movements are defined as an ongoing stream of small, circular, and elegant movements of neck, trunk, and limbs. They differ qualitatively from involuntary dyskinesias that appear to be forced. Fidgety movements of a healthy infant are a transient phenomenon; they emerge gradually at 6 weeks, come to full expression between 9 and 13 weeks post term and taper off again between the ages of 14 to 20 weeks post term.6 This is true for low-risk term as well as preterm infants whose age has been corrected.7, 8 Fidgety movements can best be observed when the infant is awake, alert, and either lying supine or sitting reclined in a baby seat. Under these conditions, normal infants aged 3 months can sustain continual fidgety movements for as long as an hour at a time. Fidgety movements will stop when the baby cries or fusses or when it is distracted by its immediate surroundings.

In previous studies9, 10 absent or abnormal quality of fidgety movements seemed to have clinical significance for predicting the later outcome of neurological impairment. To clarify this issue we did a collaborative study, using the same method of assessment and follow-up but on a large scale. We aimed to answer three questions: which abnormal writhing general movements lead to absent or abnormal fidgety movements; what is the long-term neurological outcome of infants with abnormal quality of writhing movements whose general movements normalise at an early age and who develop normal fidgety movements; and what is the long-term neurological outcome of infants who show abnormal or a total lack of fidgety movements?

Section snippets

Methods

We enrolled preterm and term newborn babies from the University Hospitals of Graz, Groningen, Heidelberg, Modena, and Pisa. We included infants for whom: mother's last menstrual dates were known, brain ultrasound scans were available, general movements at various ages had been observed, at least one assessment during the period with fidgety movements (46-60 weeks postmenstrual age) had been done, and standardised repeated neurological followup until 2-years corrected age had been done.

On the

Results

The final study sample was 130 infants: 52 girls and 78 boys. Their gestational age at birth ranged from 26 to 41 weeks (median 32 weeks, IQR: 29 to 38 weeks); 74% were born preterm. The infants' birthweight ranged from 700 to 4680 g (median 1660 g, IQR: 1245 g to 2730 g).

With ultrasound scanning 70 (54%) of the 130 infants were classified as at low risk and 60 (46%) were classified as at high risk of developing neurological deficits. Of the low-risk infants 47 had no abnormalities and 23 had

Discussion

Our method of observing the quality of fidgety movements in young infants allows valid predictions about later neurological outcome to be made long before the first signs of spasticity appear. Not only are abnormal and absent fidgety movements indicative of a poor outcome but normal fidgety movements are an excellent marker for a normal neurological outcome. The qualitative assessment of general movements before the onset of fidgety movements has an equally high sensitivity but its specificity

References (22)

  • Hopkins B, Prechtl HFR. A qualitative approach to the development of movements during infancy. In: Prechtl HFR....
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