1302 The correlation between early general movement assessment and 2 year neurodevelopmental outcome in high risk infants

Abstract

<h3>Background</h3> Prechtl General Movement Assessment (GMA) is a reliable tool for identifying babies at risk of neuromotor deficit. We have previously compared our GMA results with standardised 2 year neurodevelopmental outcome for high risk infants, but our numbers were small. <h3>Objectives</h3> Our aim therefore was to increase our study population and reassess this correlation. <h3>Methods</h3> High risk infants born between 2016 and 2018 who received their neonatal care in a level 3 NICU were retrieved from neonatal databases. Those infants who had GMA were extracted and the GMA and 2 year assessments were compared. <h3>Results</h3> 83 infants born during our study period had GMA and 2 year assessments. The infants’ gestation ranged from 23⁺⁶ to 42⁺² weeks and birth weights from 488g to 4410g. All had GMA between 10 to 17 weeks of age. Most infants had 2 assessments during this time plus an early GMA between 2 to 8 weeks. All had assessments at a corrected age of 2 years using either the Bayley’s III tool or a combination of telephone interview, general health and motor function questionnaire plus PARCA-R questionnaire. Of the 83, 66(80%) had normal 2 year outcome and 63(96%) of the 66 had normal 10 to 17 week GMA; 3(4%) of the 66 had equivocal 10 to 17 week GMA. None of the 66 had absent fidgety movements. 34(52%) of the 66 had GMA between 2 to 8 weeks and 20(59%) of these were a normal pattern with 14(41%) having a poor repertoire. 6(7%) of the 83 infants had severe global disability at 2 years and in all of these fidgety movements were absent at 10 to 17 week GMA. All 6 had abnormal GMA at 6–8 weeks; 4 with poor repertoire and 2 showing a cramped synchronous pattern. 7(8%) of the 83 infants had moderate or severe motor disability without significant other disability at 2 years and a diagnosis of cerebral palsy. 6(86%) out of the 7 had absent fidgety movements at 10 to 17 weeks and 1(14%) had equivocal fidgety movements. 4(57%) of the 7 had 6 to 8 week GMA; 2(50%) of the 4 displayed poor repertoire and 2(50%) showed a cramped synchronous pattern. 4(5%) of the 83 infants had significant cognitive or language disability at 2 years but no motor deficit and all these had normal fidgety movements. <h3>Conclusions</h3> Our study demonstrates a high level of correlation between absent fidgety movements at 10 to 17 week GMA and motor disability as assessed by standardised methods at 2 years. There is a weaker association between 6–8 week GMA and motor problems and this is well recognised in published literature. However it is notable that all children in our study with severe motor problems at 2 years and who had a 6–8 week GMA demonstrated either a cramped synchronous or poor repertoire pattern. We advocate the use of GMA for high risk neonates as a means of early prediction of neuromotor problems. Targeted intervention can be offered to those with abnormal findings improving final outcome.