Original Article
General Movements in Full-Term Infants with Perinatal Asphyxia Are Related to Basal Ganglia and Thalamic Lesions

https://doi.org/10.1016/j.jpeds.2010.11.037Get rights and content

Objective

To correlate the site and severity of brain lesions seen on magnetic resonance imaging (MRI) with the quality of general movements in term infants with hypoxic-ischemic encephalopathy (HIE) and compare the prognostic value of general movements and MRI for motor outcome.

Study design

Early brain MRI scans in 34 term infants with HIE not treated with hypothermia were reviewed and scored for site of injury and lesion pattern by an experienced neuroradiologist. General movement quality and trajectories at 1 and 3 postnatal months were evaluated. Motor outcome was assessed at 24 months.

Results

MRI scores for the basal ganglia and thalami, posterior limb of the internal capsule, white matter, and cortex and lesion patterns were correlated with 1-month and 3-month general movements and general movement trajectories; central gray matter scores were correlated most strongly with cramped-synchronized general movements and abnormal motor outcome. MRI scores were 100% sensitive and 72.2% specific for motor outcome, and cramped-synchronized general movements were 100% specific and 68.7% sensitive for motor outcome.

Conclusions

In term infants with HIE, the site and severity of brain lesions seen on early MRI are highly correlated with general movements. Central gray matter damage leads to cramped-synchronized general movements and poor motor outcome. Early MRI scans and general movements are complementary tools for predicting motor outcome.

Section snippets

Methods

The study group comprised term infants born at or referred to the University Hospital of Modena, Italy between 2003 and 2006, who were prospectively enrolled after informed parental consent for a research project on the diagnostic and prognostic value of spontaneous motility in infants with HIE. Ethical permission for this retrospective review of general movements and MRI was provided by the Ethical Committee of Modena Province. Inclusion criteria were birth at ≥37 weeks’ gestational age,

Perinatal Data

During the study period, 43 term-born infants fulfilled the inclusion criteria; 9 infants were not studied (5 due to loss to follow-up, 1 due to neonatal death, and 3 due to insufficient clinical data). Thus the study group comprised 34 infants (20 males, 14 females), with a mean gestational age of 40.4 ± 1.2 weeks. Cardiotocographic abnormalities were present in 25 infants, and a clearly identifiable sentinel event was seen in 6 infants (2 with placental abruption, 3 with umbilical cord

Discussion

Our comparison of early MRI brain findings and general movement assessments in term infants with HIE provides evidence of close correlations between the individual site, severity, and pattern of brain lesions and the quality of general movements. Few previous studies have examined the relationship between brain lesions and quality of general movements in term-born infants.

In full-term infants affected by neonatal cerebral infarction, Guzzetta et al27 detected movement asymmetries as early as 3

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      Citation Excerpt :

      Data on the predictors of outcomes after HIE between cooled and non-cooled infants [10,11] have clearly shown that the predictive power of the majority of outcome predictors, including Apgar score, lactate level, Sarnat score stages I-III, abnormal amplitude of integrated electroencephalography features, cranial ultrasound findings, and brain magnetic resonance spectroscopy findings, changed in the cooling era, whereas only neonatal neurologic examination and MRI findings at day 8 maintained the same predictive value as in the precooling era. Over the last three decades, a number of studies have assessed the predictive value of general movements (GMs), considered either singly or together with MRI findings, in at-risk newborn infants [12–19]. But few data are currently available regarding the possible effects of TH on GMs [20–23].

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    The authors declare no conflicts of interest.

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