Abnormal General Movements Research Articles

High Prevalence of Abnormal General Movements in Hospitalized Very Low Birth Weight Infants.

Abnormal general movements (GMs) are predictive of later risk of motor impairments in preterm infants. The goals of this study are to (1) describe the implementation of the GM assessment (GMA) in a neonatal intensive care unit (NICU) and (2) investigate the prevalence and evolution of abnormal GMs in very low birth weight (VLBW) infants. Observational study of GMs in VLBW infants (gestational age [GA] <32 weeks and/or birth weight [BW] <1,500 g) following GMA implementation in a level-IV NICU. All VLBW infants admitted between November 2017 and April 2019 were eligible for the GMA. Infants were excluded if they required high-frequency ventilation or if they could not be unbundled for video acquisition. GMAs were scored weekly by at least 2 GMA-certified providers. The GMA was performed in 121 VLBW infants with a mean (standard deviation [SD]) GA of 28.3 (2.6) and BW of 1,113 (400 g). Only 28% of infants had normal GMs on initial assessment (32.9 ± 2.7 weeks' GA), while 61 and 11% had poor repertoire and cramped-synchronized GMs, respectively. At NICU discharge (37.6 ± 3.4 weeks corrected GA), 45 and 21% of infants were classified as having poor repertoire and cramped-synchronized GMs, respectively. Most infants with cramped-synchronized GMs on initial assessment had persistent abnormal GMs at discharge. In contrast, only one infant with normal GMs on first assessment developed cramped-synchronized GMs. Abnormal GMs are common in VLBW infants, including a high prevalence of the more concerning cramped-synchronized movement pattern. The GMA can be successfully performed in VLBW infants. The GMA may be helpful in identifying infants at increased risk of later motor impairments, as well as assisting clinicians, in the stratification of infants who may benefit from additional brain imaging and/or an intensive hospital-based interventions. · Abnormal GMs are common in VLBW infants.. · Poor repertoire in the most prevalent pattern observed.. · Infants at risk for abnormal motor outcomes can be identified in the NICU..

The Effect of Massage Stimulation on the General Movements Quality in Breastfed Preterm Infant

General Movements (GMs) assessment is one of the modalities to detect abnormal infant development early, the examination of preterm infant development is very important. Preterm infant has a long-term health impact and the risk of neonatal morbidity and mortality, need breast milk as the best nutritionand also need stimulation, one of which is massage. This study aimto analyze massage stimulation effect on the general movements in breastfed preterm infant in Dr. Soetomo Hospital Surabaya.A randomize control group pre test post test design was conducted on preterm infant, 39 babies were enrolled. Massage stimulation was done for 10 consecutive days 3 times in the neonatal ward while observing the condition.The quality assessment of GMs is according to the standardization of the Prechtl method, through two stages, taking video recording and editing GMs, and analysis the video recordings of GMs.Statistical by comparison test.The quality of preterm GMs in massage group (85.7%) and control group(69.6%) with p=0.287. The quality of GMs writhing in the massage group was dominated by abnormal GMs (65%), in control group were dominated by normal (63.2%) with p=0,150. In the fidgety GMs, the massage group (75%) and not massage (78.9%) were dominated by normal GMs, with p=1,000.There were no differences in the quality of preterm GMs, writhingGMs and fidgetyGMs for preterm infants in both group.

The General Movements Assessment in Neonates With Hypoxic Ischemic Encephalopathy.

Clinical measures after birth and studies such as electroencephalogram (EEG) and brain imaging do not fully predict neurodevelopmental outcomes of infants with hypoxic-ischemic encephalopathy. Early detection of adverse neurologic outcomes, and cerebral palsy in particular, in high-risk infants is essential for ensuring timely management. The General Movements Assessment is a tool that can be used in the early detection of cerebral palsy in infants with brain injury. The majority of studies on the General Movements Assessment in the late preterm and term population were performed prior to the introduction of therapeutic hypothermia. To apply the General Movements Assessment in late preterm and term infants with hypoxic-ischemic encephalopathy (including those who received therapeutic hypothermia), to determine if clinical markers of hypoxic-ischemic encephalopathy predict abnormal General Movements Assessment findings, and to evaluate interrater reliability of the General Movements Assessment in this population. Study design: Pilot prospective cohort study Subjects: We assessed 29 late preterm and full-term infants with mild, moderate, and severe hypoxic-ischemic encephalopathy in Philadelphia, PA. Most infants' general movements normalized by the fidgety age. Only infants with moderate or severe hypoxic-ischemic encephalopathy had abnormal general movements in both the writhing and the fidgety ages (n = 6). Seizure at any point during the initial hospitalization was the clinical sign most predictive of abnormal general movements in the fidgety age (sensitivity 100%, specificity 55%, positive predictive value 40%, negative predictive value 100%). Interrater reliability was greatest during the fidgety age (κ = 0.67). Seizures were the clinical predictor most closely associated with abnormal findings on the General Movements Assessment. However, clinical markers of hypoxic-ischemic encephalopathy are not fully predictive of abnormal General Movements Assessment findings. Larger future studies are needed to evaluate the associations between the General Movements Assessment and childhood neurologic outcomes in patients with hypoxic-ischemic encephalopathy who received therapeutic hypothermia.

The Effect of Massage Stimulation on the General Movements Quality in Breastfed Preterm Infant

General movements (GMs) assessment is one of the modalities to detect abnormal infant development early, the examination of preterm infant development is very important. Preterm infant has a long-term health impact and the risk of neonatal morbidity and mortality, need breast milk as the best nutrition and also need stimulation, one of which is massage. This study aim to analyze massage stimulation effect on the general movements in breastfed preterm infant in Dr. Soetomo Hospital, Surabaya. A randomize control group pre-test post-test design was conducted on preterm infant, 39 babies were enrolled. Massage stimulation was done for 10 consecutive days 3 times in the neonatal ward while observing the condition. The quality assessment of GMs is according to the standardization of the Prechtl method, through two stages, taking video recording and editing GMs, and analysis the video recordings of GMs. Statistical by comparison test. The quality of preterm GMs in massage group (85.7%) and control group (69.6%) with p=0.287. The quality of GMs writhing in the massage group was dominated by abnormal GMs (65%), in control group were dominated by normal (63.2%) with p=0.150. In the fidgety GMs, the massage group (75%) and not massage (78.9%) were dominated by normal GMs, with p=1.000. There were no differences in the quality of preterm GMs, writhing GMs and fidgety GMs for preterm infants in both group.

The general movement checklist: A guide to the assessment of general movements during preterm and term age

ObjectivesTo develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score. MethodsThree examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31–45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers’ satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction). ResultsThe scorers’ satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p<0.001). The checklist score also differentiated between poor-repertoire (median=13) and cramped-synchronized general movements (median=7; p=0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal general movements was good to excellent (Kappa=0.68–1.00); (ii) the distinction between the four general movement categories was considerable to excellent (Kappa=0.56–0.93); (iii) the checklist was good to excellent (ICC=0.77–0.96). ConclusionThe general movement checklist proved an important tool for the evaluation of normal and abnormal general movements; its score may potentially document individual trajectories and the effect of therapeutic intervention.

Enhancing early detection of neurological and developmental disorders and provision of intervention in low-resource settings in Uttar Pradesh, India: study protocol of the G.A.N.E.S.H. programme

IntroductionAround 9% of India’s children under six are diagnosed with neurodevelopmental disorders. Low-resource, rural communities often lack programmes for early identification and intervention. The Prechtl General Movement Assessment (GMA) is...

Influence of infections on the quality of general movements in premature infants

IntroductionThe task of contemporary neonatology is not only to save the lives of children born prematurely, but also to provide them with the highest possible quality of life. The Prechtl method, one of several methods of assessing the quality of general movement patterns, enables early identification of immaturity or damage to the central nervous system. AimDynamic assessment of the type and quality of general movement (GMs) in preterm infants to determine indications for early neurodevelopmental support and to identify the relationship between the occurrence of maternal and neonatal perinatal risk factors and the type and quality of general movements. Material and method90 infants were assessed between 28 0/7 and 36 6/7 weeks gestational age. Dominant cases (57 cases) were infants born between 32 and 36 weeks GE. Most cases (48) received low Apgar score at 1 min (≤7), including two born in very severe condition. Neonatal infections were diagnosed in 26 infants. The study included three GM assessments: I – up to 14th day post-partum, II at term and III between 12 and 15 weeks corrected age. The analysis included gestational age, general condition of the newborn as per Apgar score as well as early and late infections. ResultsNeonatal infections were found to show a close correlation with the occurrence of abnormal general movements. It was confirmed that gestational age and congenital infections are important variables affecting the occurrence of abnormal general movements.

SAT-103 Extrauterine Growth Restriction (EUGR) in Preterm Infants: Incidence, Risk Factors, Nutrition, Auxological and Neurological Outcome.A Retrospective Study from 2010 to 2016

EUGR is still a serious problem in very low birth weight preterm infants. The gradual improvement in neonatal intensive care has allowed the survival of newborns with increasing low weight and gestational age, with a higher incidence of major nutritional problems and diseases (Goldenberg 2008). EUGR was defined as growth parameters ≤ 10° centile at discharge, compared to the expected intrauterine growth for post-menstrual age. Recently EUGR was defined, in a dynamic way, as the reduction in anthropometric parameters z-score between birth and discharge >1SD (Griffin 2016). Aims of our study were to evaluate: the incidence of EUGR, the nutritional intake, the main risk factors, the auxological and neurological outcome. We enrolled 346 newborns admitted to our NICU from 2010 to 2016 with gestational age (GA) at birth < 30 weeks and/or birth weight <1500 gr. Infants with malformations or syndromes were excluded. The incidence of EUGR was 73.1% for weight, 66.3% for length and 39.3% for head circumference. We observed a decrease in SD mainly during the first 14 days of life. From two weeks to discharge, no significant catch-up growth was observed. Risk factors for EUGR were: male gender, reduced GA (p=0.000), low birth weight (p=0.000), lower minimum weight achieved (p=0.000), more time to recover birth weight (p=0.000), lower growth rate per day (p=0.001), longer period of total parenteral nutrition (p=0.008), later onset of minimal enteral feeding (p=0.006), later achievement of the full enteral feeding (p=0.000), cesarean section (p=0.006), incomplete corticosteroid prophylaxis (p=0.025), postnatal steroids use (p=0.000), mechanical ventilation (p=0.000), pulmonary bronchodysplasia (p= 0.000), leukomalacia (p=0.06), patent ductus arteriosus (p=0.000), retinopathy of prematurity (p= 0.008), late onset sepsis (p= 0.09). In 197 patients post-discharge clinical follow up at 1, 3 and 24 months of correct age (CA) was performed. Around 88% of all our sample showed normal neurological development. 12% at 1 and 3 months had abnormal general movements (both writhing and fidgety movements) or absent (p = 0.001). At 24 months CA patients with abnormal/absent fidgety movements had neurological disabilities and 83% were EUGR. At 24 months, 17% had weight <10th centile and all were EUGR. 25% showed an overgrowth (weight >75th centile) with a probably increased risk of metabolic disease later in life. The incidence of EUGR increased over the years due to the augmentation in preterm births with lower GA. The first 14 days of life were a critical period and nutrition is known to be mandatory to promote newborns’ growth (Asbury 2019). The EUGR condition negatively affected the neurological (Chien 2018) and auxological (Takayanagi 2018, Wood 2018) outcome of preterm infants and the early recognition of this condition is extremely important in order to implement a careful and prolonged follow-up.

Assessment of general movement among infants not at risk of developmental delay

Introduction. The functional assessment of general movements (GMs) is a common test for the developing nervous system. The high predictive validity of abnormal GMs for cerebral palsy has been documented among preterm infants. Aim. The present study examined whether term infants without any documented risk factors for neurodevelopment delay may benefit from an assessment of GMs. Material and Methods. One hundred and four infants ranging in age from 1–4 months were evaluated using Prechtl’s method, of which, thirty-eight were younger than two months of age and the remaining sixty-eight were older than two months of age (with available detailed neonatal characteristics). The following movements were considered among younger infants, writhing, poor repertoire and cramped synchronised, whereas fidgety, cramped synchronised, poor repertoire, chaotic and abnormal GMs were evaluated in older infants. Infants were classified as ‘normal’ or ‘abnormal’ groups based on their presenting GMs. We determined postural positional preference, following Kaplan recommendations, with features categorised as either ‘present’ or ‘absent’, as well as activity level and general muscle tone (‘normal’ or ‘abnormal’). Results. Cramped synchronised GMs were observed in seven (18.4%) younger infants and in eleven (16.7%) older infants. There was no difference in the clinical characteristics of children with normal vs. abnormal GMs. Abnormal muscle tone was associated with a higher OR (p = 0.0039) of presenting with abnormal GMs (4.6063; 95%CI: 1.6303–13.0149). Although the infants studied were not at risk for developmental disorders, almost one-fifth required follow-up neurological consultation. Conclusions. An assessment of GMs should be considered as a universal screening tool among healthy infants without risk factor(s) for developmental deficits.

Correlates of Normal and Abnormal General Movements in Infancy and Long-Term Neurodevelopment of Preterm Infants: Insights from Functional Connectivity Studies at Term Equivalence.

Preterm infants born before 32 weeks gestation have increased risks for neurodevelopmental impairment at two years of age. How brain function differs between preterm infants with normal or impaired development is unknown. However, abnormal spontaneous motor behavior at 12–15 weeks post-term age is associated with neurodevelopmental impairment. We imaged brain blood oxygen level-dependent signals at term-equivalent age in 62 infants born at <32 weeks gestation and explored whether resting state functional connectivity (rsFC) differed with performances on the General Movement Assessment (GMA) at 12–15 weeks, and Bayley III scores at two years of corrected age. Infants with aberrant general movements exhibited decreased rsFC between the basal ganglia and regions in parietal and frontotemporal lobes. Infants with normal Bayley III cognitive scores exhibited increased rsFC between the basal ganglia and association cortices in parietal and occipital lobes compared with cognitively impaired children. Infants with normal motor scores exhibited increased rsFC between the basal ganglia and visual cortices, compared with children with motor impairment. Thus, the presence of abnormal general movements is associated with region-specific differences in rsFC at term. The association of abnormal long-term neurodevelopmental outcomes with decreased rsFC between basal ganglia and sub-score specific cortical regions may provide biomarkers of neurodevelopmental trajectory and outcome.

General movement assessment as a tool for determining the prognosis in infantile cerebral palsy in preterm infants: a systematic review

Cerebral palsy is considered to be the main cause of physical disability in childhood. General movements are an assessment tool in order to predict the neurological and long-term outcome of the newborn. To analyze the current evidence on the general movements assessment in preterm infants as cerebral palsy prognostic tool. Systematic review following PRISMA statements. Databases consulted were: PubMed/Medline, Lilacs, IBECS, Cochrane, PEDro, Cinhal, Sport Discuss, Phyinfo, Academic Search Complete, Web of Science, and SciELO. We included studies that evaluated general movements in the first 20 weeks premature newborns. We excluded studies where the sample submit other pathologies or medication was administered. Newcastle-Ottawa Scale was used to assessment the risk of bias. Ten cohort studies form this review. 2243 premature, with an average of 30.9 weeks of gestation, were analyzed. General movements recording was carried out between 5 and 30 minutes. When there are abnormal general movements, the chances of neurological involvement increase during development, whereas when normal general movements are evaluated, there will rarely be a subsequent cerebral palsy diagnosis. The predictive validity of the preterm general movements assessment is confirmed as a tool to predict cerebral palsy early. Since preterm infants are more likely to trigger abnormal general movements, it is interesting to promote this type of assessment.

The role of the family in early intervention of preterm infants with abnormal general movements.

Objectives:To determine the effect of family-based intervention on motor function in preterm infants.Methods:This study was designed as a randomized controlled trial between August 2015 and September 2016. Forty-two preterm infants were randomized and split equally between the family-based intervention group, composed of a physiotherapeutic and a familial component (8 males, 8 females; mean age 91±3.09 days), and the traditional early intervention group (8 females, 8 males, mean age: 91.06±2.4 days). Both groups received a treatment program based on a neurodevelopmental approach during 3- to 12-months-old. The groups were evaluated at corrected ages of the third, sixth, ninth, twelfth, and 24th months using the Bayley Scale of Infant and Toddler Development, Third Edition (Bayley-III).Results:Within-group changes over time were statistically significant using multivariate tests of fine motor (Multivariate analysis of variance (MANOVA); F=1515.27, p<0.001) and gross motor (MANOVA; F=1950.59, p=0.001) development. However, there was no interaction between groups in fine (MANOVA; F=0.027, p=0.872) and gross motor development (MANOVA; F=0.022, p=0.883).Conclusion:The early intervention approaches might support fine and gross motor function development in preterm infants in the first year of life.

Early motor and pre-linguistic verbal development in Prader-Willi syndrome – A case report

BackgroundPrader-Willi syndrome (PWS) is a rare genetic disorder. Infants with PWS show a neurodevelopmental dysfunction which entails a delayed motor and language development, but studies on their spontaneous movements (i.e. general movements) or pre-linguistic speech-language development before 6 months of age are missing so far. AimTo describe early motor and pre-linguistic verbal development in an infant with PWS. Methods and proceduresProspective case report; in addition to the assessment of general movements and the concurrent movement repertoire, we report on early verbal forms, applying the Stark Assessment of Early Vocal Development-Revised. Outcomes and resultsGeneral movements were abnormal on days 8 and 15. No fidgety movements were observed at 11 weeks; they only emerged at 17 weeks and lasted until at least 27 weeks post-term. The movement character was monotonous, and early motor milestones were only achieved with a delay. At 27 weeks the infant produced age-adequate types of vocalisations. However, none of the canonical-syllable vocalisations that typically emerge at that age were observed. Early vocalisations appeared monotonous and with a peculiarly harmonic structure. Conclusions and implicationsEarly motor and pre-linguistic verbal behaviours were monotonous in an infant with PWS throughout his first 6 months of life. This suggests that early signs of neurodevelopmental dysfunction (i.e. abnormal general movements) might already be diagnosed in infants with PWS during their first weeks of life, potentially enabling us to diagnose and intervene at an early stage.

Brain structure and neurological and behavioural functioning in infants born preterm.

To examine: (1) relationships between brain structure, and concurrently assessed neurological and behavioural functioning, in infants born preterm at term-equivalent age (TEA; approximately 38-44wks); and (2) whether brain structure-function relationships differ between infants born very (24-29wks) and moderate-late (32-36wks) preterm. A total of 257 infants (91 very preterm, 166 moderate-late preterm; 120 males, 137 females) had structural magnetic resonance imaging (MRI) and neurological and behavioural assessments (Prechtl's general movements assessment, Neonatal Intensive Care Unit Network Neurobehavioral Scale [NNNS] and Hammersmith Neonatal Neurological Examination [HNNE]). Two hundred and sixty-three infants (90 very preterm, 173 moderate-late preterm; 131 males, 132 females) had diffusion MRI and assessments. Associations were investigated between assessment scores and global brain volumes using linear regressions, regional brain volumes using Voxel-Based Morphometry, and white matter microstructure using Tract-Based Spatial Statistics. Suboptimal scores on some assessments were associated with lower fractional anisotropy and/or higher axial, radial, and mean diffusivities in some tracts: NNNS attention and reflexes, and HNNE total score and tone, were associated with the corpus callosum and optic radiation; NNNS quality of movement with the corona radiata; HNNE abnormal signs with several major tracts. Brain structure-function associations generally did not differ between the very and moderate-late preterm groups. White matter microstructural alterations may be associated with suboptimal neurological and behavioural performance in some domains at TEA in infants born preterm. Brain structure-function relationships are similar for infants born very preterm and moderate-late preterm. Brain volume is not related to neurological/behavioural function in infants born preterm at term. White matter microstructure is related to some neurological/behavioural domains at term. Brain-behaviour relationships are generally similar for infants born very preterm and moderate-late preterm.

The early motor development in children diagnosed with ADHD: a systematic review.

Although there is limited knowledge about early signs of ADHD, deviations in motor development are suggested as a possible indicator of such early signs. The purpose of the present systematic review was to gather knowledge about motor development before three years of age in children later diagnosed with ADHD. A systematic search was completed in four research databases, and the quality of the identified studies was systematically assessed. Of 440 initial search results, only five studies met the inclusion criteria and were fully abstracted. Major methodological heterogeneity was found between the studies, and the results are pointing in various directions. One study found an association between delay in gross motor development and ADHD, while another did not. However, associations between both good early motor development as well as delayed were also found in one study. A study of premature infants showed no association between early motor development and attention problems at school age, and a study of high-risk children from a neonatal care unit found no association between abnormal general movements and later ADHD without comorbidity. The results of the studies are pointing in various directions. No firm conclusion can be drawn on early motor development in children with ADHD due to the very different results of the studies and the methodological heterogeneity.

Preschool predictive value of abnormal general movements at 10–15 weeks corrected age in high‐risk infants

Preschool predictive value of abnormal general movements at 10–15 weeks corrected age in high‐risk infants

The general movement assessment in non-European low- and middle-income countries.

ABSTRACTAbnormal general movements are among the most reliable markers for cerebral palsy. General movements are part of the spontaneous motor repertoire and are present from early fetal life until the end of the first half year after term. In addition to its high sensitivity (98%) and specificity (91%), the assessment of general movements is non-invasive and time- and cost-efficient. It is therefore ideal for assessing the integrity of the young nervous system, most notably in lowresource settings. Studies on the general movements assessment in low- and middle-income countries such as China, India, Iran, or South Africa are still rare but increasing. In Brazil, too, researchers have demonstrated that the evaluation of general movements adds to the functional assessment of the young nervous system. Applying general movements assessment in vulnerable populations in Brazil is therefore highly recommended.

Preterm and term-equivalent age general movements and 1-year neurodevelopmental outcomes for infants born before 30weeks' gestation.

To examine the associations between Prechtl's General Movements Assessment (GMA), conducted from birth to term-equivalent age, and neurodevelopmental outcomes at 12months corrected age, in infants born very preterm. One hundred and thirty-seven infants born before 30weeks' gestation had serial GMA (categorized as 'normal' or 'abnormal') before term and at term-equivalent age. At 12months corrected age, neurodevelopment was assessed using the Alberta Infant Motor Scale (AIMS); Neurological, Sensory, Motor, Developmental Assessment (NSMDA); and Touwen Infant Neurological Examination (TINE). The relationships between GMA at four time points and 12-month neurodevelopmental assessments were examined using regression models. Abnormal GMA at all time points were associated with worse continuous scores on the AIMS, NSMDA, and TINE (p<0.05). Abnormal GMA before term and at term-equivalent age were associated with increased odds of mild-severe dysfunction on the NSMDA (odds ratio [OR] 4.26, 95% confidence interval [CI] 1.55-11.71, p<0.01; and OR 4.16, 95% CI 1.55-11.17, p<0.01 respectively) and abnormal GMA before term with increased odds of suboptimal-abnormal motor function on the TINE (OR 2.75, 95% CI 1.10-6.85, p=0.03). Abnormal GMA before term and at term-equivalent age were associated with worse neurodevelopment at 12months corrected age in children born very preterm. Abnormal general movements before term predict developmental deficits at 1year in infants born very preterm. General Movements Assessment before term identifies at-risk infants born very preterm.

A new method for early detection of infants at risk of long-term neuromotor disabilities

General movements (GM) are used in academic settings to predict developmental outcome in infants born preterm. However, little is known about the implementation and predictive value of GM in non-academic settings.The aim of this study is twofold: To document the implementation of GM assessment (GMA) in a non-academic setting and to assess its predictive value in infants born preterm.We documented the process of implementing GMA in a non-academic outpatient clinic. In addition, we assessed the predictive value of GMA at 1 and 3 months’ corrected age for motor and cognitive development at 2 years in 122 children born <33 weeks’ gestation. Outcome at two years was based upon the Bayley Scales of Infant Development-II (mental/psychomotor developmental index (MDI, PDI)) and a neurological examination. The infants’ odds of atypical outcome (MDI or PDI ≤70 or diagnosis CP) and the predictive accuracy of abnormal GMA were calculated in a clinical routine scenario, which used all available GM information (primarily at 3 months or at 1 month, when 3 months were not available). In addition, separate analysis was undertaken for the samples of GMA at 1 and 3 months.Tips to facilitate GMA implementation are described. In our clinical routine scenario, children with definitely abnormal GM were more likely to have an atypical two-year outcome than children with normal GM (OR 13.2 (95% CI 1.56; 112.5); sensitivity 55.6%, specificity 82.1%). Definitely abnormal GM were associated with reduced MDI (−12.0, 95% CI −23.2; −0.87) and identified all children with cerebral palsy (CP) in the sample of GMA at 3 months only.GMA can be successfully implemented in a non-academic outpatient setting. In our clinical routine scenario, GMA allowed for adequate prediction of neurodevelopment in infants born preterm, thereby allaying concerns about diagnostic accuracy in non-academic settings.

Abnormal general movements during the fidgety period and abnormal neurologic examinations at 18-24 months in a high risk United States population

Abnormal general movements during the fidgety period and abnormal neurologic examinations at 18-24 months in a high risk United States population