Original articleUsing the Alberta Infant Motor Scale to early identify very low-birth-weight infants with cystic periventricular leukomalacia
Introduction
Great improvements in neonatal intensive care during the last decade have raised the survival rate for very low birth weight (VLBW) preterm infants, those with a birth body weight (bbw) (<1500 g) [1], [2]. Of VLBW infants who survive, 15% have cerebral palsy, and 50% have significant cognitive, behavioral, and attentional deficits that require special education [3], [4], [5], [6].
Periventricular leukomalacia (PVL) is the most common brain injury in premature infants and it often develops into cerebral palsy in later life [7], [8], [9]. PVL is characterized by focal necrosis in developing cerebral white matter dorsal and lateral to the external angles of the lateral ventricle as a result of hypoxic-ischemic or infection insults [7], [10]. Focal necrosis can be macroscopic in size, include the loss of cellular elements (pre-oligodendrocytes and axons), lead to the formation of cysts, and be visualized using cranial ultrasonography [6], [11]. In this particular area, the corticospinal tracts innervating muscles in the lower extremities descend from their origin in the motor cortex through the white matter and into the internal capsule [10]. Depending on the extent and severity of the white-matter damage, infants with PVL develop different degrees of progressive motor deficits and disabilities several months after birth [7], [10].
An important aspect of the pediatrician’s evaluation of a high-risk infant is using developmental screening tools that provide information about its developmental status and making recommendations for early intervention for high-risk infants. Early intervention is more effective for high-risk children than for children with identified disabilities [12], [13], [14], [15], [16]. To help identify these high-risk infants as early as possible, a developmental screening tool for early prediction is necessary. One assessment tool particularly useful for monitoring gross motor developmental change in infants during the first 18 months of life is the Alberta Infant Motor Scale (AIMS) [17].
The AIMS is designed to examine, discriminate, and evaluate the spontaneous movement of infants from term age through independent walking, which is also useful for monitoring gross motor developmental change in infants during the first 18 months of life [17]. The AIMS demonstrates a high degree of correlation with the gross motor scale of the Bayley Scale of Infant Development (BSID) when the tests are applied on high-risk infants with motor delays [16]. The AIMS follows the principles of dynamical motor systems by observing infants as they move into and out of four positions: prone, supine, sitting, and standing. In contrast to the BSID that requires trained psychologists to administer with, the testing procedures of AIMS are administered by observation only and can be completed within 20 min, which is more feasible for clinicians than BSID.
The AIMS has been widely used to assess gross motor development in normal term infants [17], [18], [19], at-risk infants [20], infants with cerebral palsy [21], and very preterm infants [22], [23], [24]. Jeng et al. [24] observed that the AIMS provided reliable and valid measurement that was useful evaluating the gross motor function of Taiwanese preterm infants from birth to corrected age 18 months. They also demonstrated the AIMS scores correlated with the Bayley Motor Scale scores at 6 and 12 months corrected age. Most studies [20], [22], [23], [24] report that motor development in preterm infants differs from that in term infants. However, there are relatively few studies that compare the gross motor development between VLBW infants with and those without cystic PVL in the first 18 months of life [21], [22]. More important, whether the AIMS is able to identify VLBW infants with cystic PVL as early as 6 months of corrected age remains unknown.
Section snippets
Participants
The institutional review board approved this study and informed consent was obtained. VLBW preterm (gestational age ⩽27 weeks) infants were recruited from the neonatal intensive care unit at six tertiary hospitals in Southern Taiwan from 01 June 2000 through 31 May 2006. The selection criteria were (1) a bbw <1500 g, (2) born at one of six tertiary hospitals in southern Taiwan, (3) no genetic syndromes and no congenital brain malformations, (4) no intraventricular or intracerebral hemorrhage, (5)
Diagnosis
Cystic PVL was diagnosed at a mean age of 28 days (range, 21–60 days). None of the infants in cPVL+ group had intraventricular hemorrhage.
Participant characteristics
One of the 36 infants in the cPVL+ group was excluded because she developed a grade IV intraventricular hemorrhage during the study; two of the 72 infants in the cPVL− group were excluded because they were lost to follow-up; and one of the 77 infants in the HC group was excluded because of an incomplete follow-up record.
The mean gestational age, mean bbw, and
Discussion
The AIMS has been widely used, but a gross motor developmental profile of VLBW preterm infants with cystic PVL has not been previously published. We report, for VLBW preterm infants with and without cystic PVL and healthy full-term infants from 6 to 18 months old, the longitudinal development of gross motor function on four AIMS subscales and total score. The healthy full-term infants had the best gross motor performance, and the VLBW preterm infants with cystic PVL had the worst. The
References (35)
- et al.
Correlation between cerebrovascular maturity and periventricular leukomalacia
Pediatr Neurol
(2000) - et al.
Relation between the data of cyst formation observable on ultrasonography and the timing of injury determined by serial electroencephalography in preterm infants with periventricular leukomalacia
Brain Dev
(2001) Brain injury in the premature infant from pathogenesis to prevention
Brain Dev
(1997)- et al.
The effectiveness of early intervention: examining risk factors and pathways to enhanced development
Prev Med
(1998) - et al.
Intra-individual stability of rate of gross motor development in full-term infants
Early Hum Dev
(1998) - et al.
Early gross motor development of preterm infants according to the Alberta Infant Motor Scale
J Pediatr
(2006) - et al.
Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants
J Pediatr
(2004) - et al.
Possible antenatal and perinatal related factors in development of cystic periventricular leukomalacia
Brain Dev
(2005) - et al.
Cystic periventricular leukomalacia and type of cerebral palsy in preterm infants
J Pediatr
(1994) - et al.
Prognostic factors for walking attainment in very low birth weight preterm infants
Early Hum Dev
(2000)
Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. NICHD Neonatal Research Network
Pediatrics
Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis
JAMA
Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996–1997
Pediatrics
Cerebral palsy rates among low birth weight infants fell in the 1990s
Dev Med Child Neurol
Neurodevelopmental outcomes of infants born prematurely
J Dev Behav Pediatr
Pathogenesis of cerebral white matter injury of prematurity
Arch Dis Child Fetal Neonatal Ed
Neurology of the newborn
Cited by (10)
Modeling gross motor developmental curves of extremely and very preterm infants using the AIMS home-video method
2022, Early Human DevelopmentCitation Excerpt :The reasons may include that 1) the time frame of the measurements covers only the first year after birth, 2) larger age intervals are used between measurements, and 3) motor developmental analyses are performed on the entire sample, possibly resulting in higher average gross motor scores [7,16,25,26,38]. In a study by Wang et al. (2013) of Taiwanese VLBW infants, with and without PVL, compared to TB infants measured with the AIMS at 6, 12, and 18 months (CA), the former did not score significantly differently from the TB infants from 12 months onwards [54]. Although this study is not fully comparable to our study, it does provide information that there are VPT infants who develop similarly to TB infants.
Motor development of preterm infants assessed by the Alberta Infant Motor Scale: systematic review article
2017, Jornal de PediatriaCitation Excerpt :The authors11,12 described significantly lower total scores than those observed for the controls, as well as lower scores in the sitting and standing subscales, demonstrating a motor delay in more vertical postures in this age group. Five studies found differences in MD at 12 months of CoA, indicating lower total scores in preterm children.10,12,13,23,33 In three of these studies, extreme prematurity was the assessed group, indicating there is a specific trajectory of MD that reflects a variant of the typical MD in this population.12,13,33
Gross motor development in full-term Greek infants assessed by the Alberta Infant Motor Scale: Reference values and socioeconomic impact
2014, Early Human DevelopmentCitation Excerpt :AIMS has been broadly employed throughout the world in many studies and in daily clinical practice to evaluate motor development in full term and preterm infants. Ιt has also been used to investigate the influence of several medical and environmental factors on the infant's motor development [5–17]. However, it has been questioned whether the scores of the original Canadian sample could be representative of those of infants of other nationalities.
The standardization of the Polish version of the Alberta Infant Motor Scale
2023, BMC PediatricsThe Polish Version of the Alberta Infant Motor Scale: Cultural Adaptation and Validation
2022, Frontiers in Neurology