Elsevier

Brain and Development

Volume 35, Issue 1, January 2013, Pages 32-37
Brain and Development

Original article
Using the Alberta Infant Motor Scale to early identify very low-birth-weight infants with cystic periventricular leukomalacia

https://doi.org/10.1016/j.braindev.2011.08.012Get rights and content

Abstract

We examined whether the Alberta Infant Motor Scale (AIMS) is able to identify very low-birth-weight (VLBW) preterm infants with cystic periventricular leukomalacia (PVL) as early as 6 months of corrected age. Longitudinal follow-up AIMS assessments were done at 6, 12, and 18 months old for 35 VLBW infants with cystic PVL (cPVL+), 70 VLBW infants without cystic PVL (cPVL), and 76 term infants (healthy controls: HC). Corrected age was used for the preterm infants. The cPVL+ group had significantly lower prone, supine and sitting subscales at age 6, 12, and 18 months than the cPVL group (all p < 0.05). The cPVL group showed significantly lower supine, prone, sitting, and standing subscales than the HC group only at age 6 months. At age 6 months, the areas under the receiver operator curve used to discriminate the cPVL+ infants from cPVL infants were 0.82 ± 0.04 for prone, 0.93 ± 0.02 for supine, 0.83 ± 0.05 for sitting, and 0.62 ± 0.07 for standing. The AIMS may help early identify VLBW infants with cystic PVL at age 6 months old.

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

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