Assessment of motor behaviour in high-risk-infants at 3 months predicts motor and cognitive outcomes in 10 years old children
Introduction
Children born prematurely and/or with neonatal encephalopathy have an increased risk for impaired neurological outcomes [1]. Abnormal motor and cognitive outcomes have especially been reported in preterm-born children with a very low birth weight (VLBW: birth weight < 1500 g) [2], [3]. Studies have shown that early intervention can reduce motor and cognitive [4], [5] impairments in early childhood. In order to intervene at an early stage and give parents the support they need, it should be a top priority to develop and improve assessment tools that reveal neurological problems at an early stage. Early resource-demanding intervention in children at risk of an impaired neurological outcome but without actual symptoms should not be initiated unless a relatively reliable prediction of outcome can be made. Several studies have described a method for such a purpose — the General Movement Assessment (GMA), developed by Prechtl et al. and based on a systematic observation and classification of spontaneous movement behaviour in infancy [6]. A set of normal general movements (GMs) was defined for the preterm, term and post-term periods. Fidgety movements (FMs) are characteristic of the spontaneous motor behaviour in 3- to 5-month-old infants. They are small movements of moderate speed and variable acceleration of the neck, trunk and limbs in any direction, and are continuous and present almost all the time [7]. The concurrent motor repertoire denotes general movements co-occurring with fidgety movements; together, they constitute the motor behaviour in 3- to 5-month-old infants. To assess the quality of these movements, the Prechtl group developed the “Assessment of Motor Repertoire” (AMR) [7]. AMR yields a motor optimality score, i.e. the sum of five parameters: fidgety movements, repertoire of co-existent other movements, quality of other movements, posture and movement character.
The GMA has mostly been used in studies to predict later development of cerebral palsy (CP) [6], [8]. Absence of fidgety movements has been shown to be predictive of later development of CP [6], [9], whereas the presence of fidgety movements has been found predictive of a normal neurological development [9], [10]. So-called “mildly abnormal GMs” have been reported as a possible risk for minor neurological dysfunction (MND) in 4- to 12-year-old children [11], [12], [13]. Recently, an association has been proposed between the quality of the spontaneous motor repertoire in early infancy and the cognitive outcome later in childhood [14], [15].
The objective of the present study was to determine the predictive value of the quality of fidgety movements and concurrent motor repertoire for the later motor and cognitive outcomes in a group of high-risk children born preterm and/or with neonatal encephalopathy. Furthermore, we aimed to examine the respective predictive values in a subgroup of infants born with VLBW. We hypothesised that the presence of fidgety movements and a normal concurrent motor repertoire were predictive of a normal cognitive and motor outcome, whereas the presence of fidgety movements with an abnormal concurrent motor repertoire was predictive of impaired motor and cognitive outcomes, especially in VLBW infants.
Section snippets
Design
The present study was a follow-up study of a group of high-risk infants treated at the Neonatal Intensive Care Unit (NICU) at St. Olav University Hospital, Trondheim, Norway. They were invited to participate in the study at 10 years of age. Data had been collected at birth and at 3 to 4 months' corrected age, and the motor and cognitive outcomes were assessed at 10 years of age.
Participants
During the years 1999, 2000, and partly in 2001, 148 VLBW children were admitted to the NICU at Trondheim University
GMA classification at 14 weeks post-term age
Table 2 shows that 14 (34%) infants in the study group had presence of fidgety movements and a normal concurrent motor repertoire. Another 17 (43%) infants had fidgety movements and abnormal concurrent motor repertoire, whereof two infants had sporadic fidgety movements at 14 weeks post term age. Another 17 (43%) infants had fidgety movements and abnormal concurrent motor repertoire. Nine (23%) showed no fidgety movements and an abnormal concurrent motor repertoire. No infant in the study group
Discussion
In high-risk children, we found that the pathological clinical outcome at 10 years of age was identified by presence of fidgety movements and an abnormal concurrent motor repertoire at 14 weeks post-term age. In line with the findings of Yang et al. [23], almost all children with CP had no fidgety movements, and all of them had an abnormal concurrent motor repertoire. None of the children with fidgety movements and a normal concurrent motor repertoire developed CP. The negative predictive values
Conclusion
In conclusion, we found that the presence of fidgety movements accompanied by an abnormal motor repertoire in infancy could be a valuable early clinical marker for an increased risk of impaired motor and cognitive outcomes in neurologically high-risk children – particularly in VLBW children – who do not develop CP. Furthermore, most children with a normal clinical outcome were identified by a normal concurrent motor repertoire in infancy. This could help to start early intervention programmes
Conflict of interest
No disclosures.
Acknowledgements
This work was supported by grants from the Norwegian Fund for Postgraduate Training in Physiotherapy and the Department of Clinical Services, St. Olav University Hospital, Trondheim. We are greatly indebted to paediatric physiotherapist Tordis Ustad, St. Olav University Hospital, for her kind assistance in assessing the children, and would also like to thank Miha Tavcar (scriptophil) for copy editing the manuscript.
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