General Movements Assessment Research Articles

Assessment of general movements in preterm infants as a predictor of cerebral palsy.

At present, the early identification of cerebral palsy still poses a major challenge for the health system worldwide. Great advances have been made in neonatology in reducing mortality, but not morbimortality. Cerebral palsy remains the most common sequela of all developmental disorders, especially among those born prematurely. The possibility of early detection before 5 months of age has many benefits for the child and their family, since it allows very early initiation of treatment. In this study, we describe a highly sensitive and specific tool known as Prechtl's assessment of general movements and its potential complementation with technological apps for early detection.

Semi-supervised body parsing and pose estimation for enhancing infant general movement assessment.

General movement assessment (GMA) of infant movement videos (IMVs) is an effective method for early detection of cerebral palsy (CP) in infants. We demonstrate in this paper that end-to-end trainable neural networks for image sequence recognition can be applied to achieve good results in GMA, and more importantly, augmenting raw video with infant body parsing and pose estimation information can significantly improve performance. To solve the problem of efficiently utilizing partially labeled IMVs for body parsing, we propose a semi-supervised model, termed SiamParseNet (SPN), which consists of two branches, one for intra-frame body parts segmentation and another for inter-frame label propagation. During training, the two branches are jointly trained by alternating between using input pairs of only labeled frames and input of both labeled and unlabeled frames. We also investigate training data augmentation by proposing a factorized video generative adversarial network (FVGAN) to synthesize novel labeled frames for training. FVGAN decouples foreground and background generation which allows for generating multiple labeled frames from one real labeled frame. When testing, we employ a multi-source inference mechanism, where the final result for a test frame is either obtained via the segmentation branch or via propagation from a nearby key frame. We conduct extensive experiments for body parsing using SPN on two infant movement video datasets; on these partially labeled IMVs, we show that SPN coupled with FVGAN achieves state-of-the-art performance. We further demonstrate that our proposed SPN can be easily adapted to the infant pose estimation task with superior performance. Last but not least, we explore the clinical application of our method for GMA. We collected a new clinical IMV dataset with GMA annotations, and our experiments show that our SPN models for body parsing and pose estimation trained on the first two datasets generalize well to the new clinical dataset and their results can significantly boost the convolutional recurrent neural network (CRNN) based GMA prediction performance when combined with raw video inputs.

Going Beyond Conventional Assessment of Developmental Motor Disorders: Exploring Video Methods for Early Identification Among Children 0 to 3 Years.

Motor skills and movement-related functioning significantly shape how children experience and interact with the world around them. Among infants and young children, developmental motor disorders contribute to delays with motor, cognitive, and psychosocial development. Early and accurate identification of these disorders is necessary to facilitate timely access to therapeutic interventions that minimize the long-term effects of disability on everyday activities and participation. In the United States, motor assessments commonly used among children 0 to 3 years focus on completion of specific motor skills at a single point in time, which provides only a part of the greater picture that is a child's motor and movement-related functioning. Video-capture methods, like the General Movements Assessment (GMA) and the Infant Motor Profile (IMP), offer greater accuracy and predictive power to (1) identify motor deficits in young children and (2) facilitate early access to supportive, therapeutic intervention.

Effect of bilirubin levels in infants on spontaneous activity assessed by the Prechtl method

Introduction: Neonatal jaundice is characterised by a yellow coloration of the skin, mucous membranes, and sclera of the eye resulting from the accumulation of bilirubin in the body. When produced in significant excess, bilirubin can accumulate in the central nervous system causing kernicterus (bilirubin encephalopathy). The diagnosis of jaundice based only on the visual assessment of the degree of yellowing of the skin or sclera and the urine output is not a reliable method. Even the assessment by experienced observers does not correlate with actual measurements of serum bilirubin levels. Therefore, a study was undertaken to determine whether other parameters could clarify the diagnosis of neonatal jaundice during the observation of an infant. The aim of this study was to analyse the effect of bilirubin levels on motor activity of the infants studied in terms of the quality of motor patterns assessed using the Prechtl method. Materials and methods: The research procedure was multistage and included a retrospective analysis of neonatal medical records, transcutaneous measurement of bilirubin levels, and analysis of neonatal activity performed based on video recordings. A qualitative assessment of neonatal spontaneous activity was performed using the Prechtl GMA method (general movement assessment). The research procedure consisted of two stages. The first stage involved selecting infants who had a good general health status. Based on these criteria, a total of 125 infants were included in the video recording. The second stage of study inclusion took place after video recording. Infants with short periods of wakefulness, prolonged crying, and lying on their side were excluded from further examinations. Ultimately, 52 infants were included in the study. All infants were subjected to the diagnostic method proposed by Prechtl to determine the effect of bilirubin levels on their motor activity. Conclusion: Bilirubin levels in the course of physiological jaundice did not affect the quality of motor repertoire in the group of infants studied. Therefore further research is needed.

An Algorithm for the Detection of General Movements of Preterm Infants Based on the Instantaneous Heart Rate.

Video recording and editing of general movements (GMs) takes time. We devised an algorithm to automatically extract the period of GMs emergence to assist in the assessment of GMs. The algorithm consisted of δHR: subtracting the moving average heart rate (HR) for the past 60 s from the average instantaneous HR; and %δHR: the percentage of the instantaneous HR to the moving average HR. Ten-second sections in which δHR was positive for three consecutive sections and contained at least one section with %δHR > 105% were extracted. Extracted periods are called automated extraction sections (AESs). We evaluated the concordance rate between AESs and GMs in three periods (gestational age 24-32, 33-34, and 35-36 weeks). The records of 84 very low birth weight infants were evaluated. Approximately 90% of AESs were accompanied by GMs at any period in both the supine and prone positions. The proportion of full-course (beginning to end) GMs among GMs in the AES was 80-85% in the supine position and 90% in the prone position in all periods. We could extract a sufficient number of assessable GMs with this algorithm, which is expected to be widely used for assisting in the assessment of GMs.

General Movement Assessment in Babies Born Preterm: Motor Optimality Score–Revised (MOS-R), Trajectory, and Neurodevelopmental Outcomes at 1 Year

To assess the association between the General Movement Assessment (GMA) findings, including Motor Optimality Scores-Revised (MOS-R) at 16weeks, and neuromotor outcome assessed by the Amiel-Tison Neurological Assessment at 9months of corrected age and the Developmental Assessment Scales for Indian Infants (DASII) at 1year of corrected age in preterm ≤32weeks. Serial GMA videos of infants born preterm ≤32weeks were recorded on day 7, 35weeks of postmenstrual age, 40weeks of postmenstrual age, and 16weeks of corrected age. The association between GMA findings, including MOS-R scores and GM trajectory between 35 to 40weeks and the Amiel-Tison Neurological Assessment and DASII scores, was assessed by Spearman correlation, Fisher exact tests, and ordinal regression. Moderate correlations were observed between MOS-R and the DASII motor DQ (Spearman r=0.70, P<.001) and between MOS-R and DASII Mental DQ (r=0.65, P<.001). The GMA trajectory at 35-40weeks was associated with DASII motor DQ (Fisher exact, P=.002), and also with the Amiel-Tison Neurological Assessment at 9months of corrected age (P<.01 by the Fisher exact test). On analysis by performing ordinal regression of predictive values of the general movements (GM)at 7days of age, GM at 35weeks, GM at 40weeks, GM at 16weeks, and MOS-R at 16weeks, MOS-R alone was a statistically significant predictor of motor DQ at 1year of age (OR -0.59; 95% CI -0.97 to -0.22; Wald statistics, P<.02). Consistent with findings in high-income countries, GMA including MOS-R scores performed in Indian infants born preterm during the neonatal period and early infancy is associated with neurodevelopmental outcomes in the first year of life. GMA can help initiate focused early intervention in low- and middle-income settings, where resources may be limited.

Identification of risk factors in pre-term infants with abnormal general movements.

This study aimed to investigate the relationship between prenatal, perinatal, and postnatal risk factors for neurodevelopmental impairment (NDI) with the outcomes of General Movement (GM) Assessment (GMA) in pre-term infants at 3-5 months of age. We sought to identify the risk factors associated with the predictors of psychomotor development in pre-term newborns, such as normal fidgety movements (FMs), absent FMs, or abnormal FMs, assessed during the fidgety period of motor development. The SYNAGIS program (prophylactic of Respiratory Syncytial Virus Infection) was used to identify risk factors for the development of neuromotor deficits in 164 pre-term infants who were at high risk of developing these deficits. Based on the GMA, all participants were divided into three groups of infants who presented: (1) normal FMs; (2) absent FMs; and (3) abnormal FMs. The results of the current study suggest that abnormal GMs not only indicate commonly known factors like birth asphyxia (BA), respiratory distress syndrome (RDS), periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH) grades 3-4, but also predict the development of motor impairments. In the present study, several specific risk factors including bronchopulmonary dysplasia (BPD), infertility treatments, maternal acute viral/bacterial infections during pregnancy, and elevated bilirubin levels were identified as attributes of an atypical fidgety movement pattern. Additional clinical data, such as risk factors for NDI associated with early predictors of psychomotor development in pre-term newborns, i.e., absent or abnormal FMs, may be helpful in predicting neurological outcomes in pre-term infants with developmental concerns in the 1st month of life.

The Importance of Monitoring Neurodevelopmental Outcomes for Preterm Infants: A Comparison of the AIMS, GMA, Pull to Sit Maneuver and ASQ-3.

Clinicians and parents should closely monitor the neurodevelopment of very preterm infants. The aim of our study was to compare whether neurodevelopmental assessments completed by parents and those done by specialists yielded similar outcomes. We wanted to check whether the assessments completed by specialists and parents were comparable in outcomes to emphasize the important roles of early assessment of a child and of the parents in their child's treatment and medical care. Another aim was to check whether or not the pull to sit maneuver from the Neonatal Behavioral Assessment Scale (NBAS) is still a parable item in well-known scales of neurodevelopment. We assessed 18 preterm neonates in the fourth month of corrected age with scales such as the General Movement Assessment (GMA), the Alberta Infant Motor Scale (AIMS), and the pull to sit maneuver from the NBAS. Finally, we asked parents to complete the Ages and Stages Questionnaire, Third Edition (ASQ-3). We found that the respective assessments completed by specialists and parents are comparable in outcomes. We also found that the pull to sit item from the NBAS was still a valid test since it showed similar findings to those from the AIMS, the GMA, and the ASQ-3. The pull to sit item from the NBAS is an important item for assessment of very preterm infants. Specialists should also take into consideration the input and concerns of parents when planning for treatment and intervention.

Preterm infant general movements assessment via representation learning

General movements assessment (GMA) is essential for abnormal movement screening and timely intervention of neuromotor diseases for preterm infants. Conventional preterm infant GMA requires long-term infant movement observation by medical experts with domain-specific knowledge, which is labor-intensive. To bridge the gap between time-consuming observation-based conventional GMA and cost-effective video-based automatic GMA for preterm infants, we contribute a smartphone video dataset dedicated to full-body movement of 87 preterm infants and propose a video-based preterm infant abnormal movement detection system that can be generalized to preterm infant GMA beyond our dataset. Our system first extracts the trajectories of the body key-points with HRNet to learn the representations that are most relevant to the movement while avoiding the irrelevant appearance-related features, and then returns a normal/abnormal movement binary prediction with CTR-GCN for automatic preterm infant GMA. Unlike most existing works that adopts the mixture of full-term and preterm infants or the second-stage preterm infants for GMA, our dataset purely focuses on the first-stage preterm infants for in-time prediction. Experimental results show that our system outperforms the competing GMA schemes and achieves a 95.54% accuracy rate in terms of the detection of intra-subject potential neuromotor diseases.

Accelerometer measures in extremely preterm and or extremely low birth weight infants and association with abnormal general movements assessments at 28- and 32-weeks postmenstrual age

BackgroundAssessment of general movements (GMs) in preterm infants is qualitative and potentially subjective. Accelerometers provide quantitative data that could overcome the problems of the GMs assessment. Study aimsTo determine if quantitative measures (obtained from four tri-axial accelerometers) correlate with GMs assessments performed in the preterm period at 28- or 32-weeks postmenstrual age (PMA). Study designProspective observational study. Tri-axial accelerometers were applied to the dorsum of each hand and foot at 28- and 32-weeks PMA. Simultaneous video recordings of the babies' spontaneous movements were made to assess GMs. SubjectsEligible babies were born <28-weeks PMA or had a birth weight of <1000 g. Babies were recruited before they reached 33-weeks PMA. Outcome measuresGMs assessments were made offline on the video recordings. Forty-six quantitative motor parameters were calculated during the same periods of activity and compared with GMs assessments. ResultsAt 28-weeks PMA, 24/43 (55.8 %) babies had abnormal GMs. At 32-weeks PMA, 26/57 (45.6 %) had abnormal GMs. The inter-rater reliability of the GMs was poor. When comparing MDS measures between; infants with normal and those with abnormal GMs, at 28-weeks PMA, 7/46 parameters were significantly different, and at 32-weeks PMA, 19/46 parameters were significantly different. ConclusionIsolated use of quantitative movement measures, obtained from four tri-axial accelerometers before hospital discharge, correlate with the GMs assessments at both 28-weeks and 32-weeks PMA. Accelerometers may provide a useful screening tool for abnormal GMs in preterm infants and could overcome issues with inter-rater reliability.

FP.08 Evaluating the expression of spontaneous movements in infants with neuromuscular conditions using Prechtl's General Movements Assessment

Prechtl's General Movements Assessment (GMA) was originally developed to assist in early identification of infants with cerebral palsy by using gestalt visual analysis to evaluate infants' spontaneous movements. Little is understood about the types of general movements (GMs) expressed in infants with neuromuscular disorders, or whether these infants have detectable movement abnormalities within the first weeks of life. We seek to describe the expression of GMs in infants from birth to 6 months of age with diagnosis of neuromuscular disease. Fourteen infants with an established neuromuscular diagnosis (e.g., spinal muscular atrophy [SMA], N=7; Duchenne muscular dystrophy [DMD], N=3; and others, N=4) have been enrolled, to date. The GMs of each infant were recorded for up to 4 minutes in supine using standardized procedures. Blinded assessors used global GMA categorizations and detailed GMA scoring forms to evaluate the variability and complexity of the infants' movements and determine normal vs aberrant movement patterns. Two subjects (SMA, N=1; DMD, N=1) have >1 recording over time. Of the 17 total videos collected, 14 were able to be scored by the GMA. Four (29%) were evaluated as having normal movement patterns; of those, 2 were post-treatment SMA. A sub-cohort of infants were evaluated with the Neuromuscular Gross Motor Outcome (GRO) and Bayley-4 gross motor subtest as clinical standard of care. Interestingly, there was a moderate correlation between motor performance on GRO and GMA detailed scoring (rho=0.79; p=0.01), however, Bayley-4 scaled scores do not seem to differentiate between healthy and aberrant movements. Further exploration into the influence of disease-modifying treatments on the expression of GMs will be presented. While a limitation of this analysis was the small sample size, preliminary results suggest that many infants with neuromuscular disease express movement abnormalities from birth.

Motor Optimality Scores are significantly lower in a population of high-risk infants than in infants born moderate-late preterm

BackgroundThe Motor Optimality Score-Revised (MOS-R) is a detailed scoring of the General Movement Assessment (GMA), measuring the spontaneous behaviors of infants. Infants born moderate-late preterm are not traditionally followed in high-risk clinics, but have increased risk of neurodevelopmental disability. AimsCompare MOS-R at 3 months corrected age (CA) in high-risk (HR; very preterm or abnormal neuroimaging) infants to infants born moderate-late preterm (MLP). Study designIn this prospective cohort study, parents of enrolled infants created video recordings using an app at 3 months CA. Videos were scored with the General Movement Assessment (GMA) and MOS-R. MOS-R scores were divided into “higher-risk” (≤19) and “lower-risk” (≥20). Subjects181 infants born MLP or categorized as HR. ResultsAmong enrolled infants, 68 (38 %) were in the MLP group, and 113 infants were in the HR group. The HR group had 3.8 increased odds of having an aberrant GMA score compared to the MLP group (p < 0.01, 95 % CI 1.38–10.52). The HR group had significantly lower MOS-R scores (mean 20) than the MLP group (mean 24; p < 0.001; 95%CI 3.3–7.3). The HR group had 11.2 increased odds of having a higher-risk MOS-R score (95%CI 2.5–47.6, p < 0.001) than MLP group. Infants were most likely to have a lower MOS-R score if they had any of the following: VP shunt placement, periventricular leukomalacia, or bronchopulmonary dysplasia. ConclusionsAberrant GMA and higher-risk MOS-R scores were more common in infants at high-risk, reflecting history of brain lesions and younger gestational age at birth.

General Movement Assessment in Prediction of Neurodevelopmental Disability and Cerebral Palsy

General Movement Assessment in Prediction of Neurodevelopmental Disability and Cerebral Palsy

Clinical factors associated with abnormal general movements of preterm newborns during hospitalization in a neonatal intensive care unit

IntroductionThere is no clarity about which clinical variables during hospitalization in the Neonatal Intensive Care Unit (NICU) are associated with abnormal General Movements (GMs). ObjectiveTo describe the trajectory of GMs of preterm newborns and explore the association between clinical variables and the presence of abnormal GMs during the NICU stay. MethodsFifty-eight preterm newborns (33 males), with a mean gestational age at birth of 31,93 week's postmenstrual age, were evaluated using the GMs assessment by Hadders-Algra method. Clinical variables recorded weekly throughout the hospitalization period. The weekly association between clinical variables and the presence of abnormal GMs was tested using the Generalized Estimating Equations (GEE) model. ResultsPreterm infants were recorded for up to sixteen weeks and more than half of the infants (56.9 %) had abnormal movements in at least one week during hospitalization. The absence of peri-intraventricular hemorrhage (PIVH) grades I-II and non-invasive ventilatory support and/or oxygen therapy on the day of the evaluation reduced, respectively, by 77.3 % (OR = 0.23; p > 0.0001) and 64.3 % (OR = 0.36; p > 0.0001) the chance of having an abnormal classification. In addition, each day of increased invasive mechanical ventilation increased the chance of having an abnormal classification by 1.11 times (OR = 0.025; p > 0.0001). ConclusionPIVH grades I-II, longer durations of mechanical ventilation and the presence of non-invasive ventilatory support and/or oxygen therapy are associated with abnormal movements during stay in the neonatal period. The data suggest that development outcome of infants having these conditions should be closely monitored.

Characterization of Infants' General Movements Using a Commercial RGB-Depth Sensor and a Deep Neural Network Tracking Processing Tool: An Exploratory Study.

Cerebral palsy, the most common childhood neuromotor disorder, is often diagnosed through visual assessment of general movements (GM) in infancy. This skill requires extensive training and is thus difficult to implement on a large scale. Automated analysis of GM performed using low-cost instrumentation in the home may be used to estimate quantitative metrics predictive of movement disorders. This study explored if infants’ GM may be successfully evaluated in a familiar environment by processing the 3D trajectories of points of interest (PoI) obtained from recordings of a single commercial RGB-D sensor. The RGB videos were processed using an open-source markerless motion tracking method which allowed the estimation of the 2D trajectories of the selected PoI and a purposely developed method which allowed the reconstruction of their 3D trajectories making use of the data recorded with the depth sensor. Eight infants’ GM were recorded in the home at 3, 4, and 5 months of age. Eight GM metrics proposed in the literature in addition to a novel metric were estimated from the PoI trajectories at each timepoint. A pediatric neurologist and physiatrist provided an overall clinical evaluation from infants’ video. Subsequently, a comparison between metrics and clinical evaluation was performed. The results demonstrated that GM metrics may be meaningfully estimated and potentially used for early identification of movement disorders.

Early detection of developmental delay in infants born very preterm or with very low birthweight.

This study aimed to identify early clinical biomarkers from birth to 16 weeks corrected age to predict typical outcome and developmental delay in infants born very preterm or with very low birthweight. A prospective cohort of infants on the Sunshine Coast, Australia, was assessed using the Premie-Neuro Examination, the General Movement Assessment (GMA), the Alberta Infant Motor Scale, and the Infant Sensory Profile 2. At 24 months corrected age, delay was identified using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and Neurosensory Motor Developmental Assessment (NSMDA). One hundred and four infants were recruited; 79 completed outcome assessments (43 females, 36 males; mean gestational age 30 weeks [SD 1 week 6 days], mean birthweight 1346 g [SD 323]). The incidence of developmental delay (motor or cognitive) was 6.3%. Suboptimal quality of fidgety general movements (temporal organization) at 16 weeks corrected age demonstrated the best predictive accuracy (Bayley-III motor: sensitivity 100% [95% confidence interval {CI} 3-100], specificity 75% [95% CI 63-84], area under the curve [AUC] 0.87); Bayley-III cognitive: sensitivity 100% [95% CI 3-100], specificity 75% [95% CI 64-84], AUC 0.88); NSMDA motor: sensitivity 100% [95% CI 40-100], specificity 81% [95% CI 70-90], AUC 0.91 [95% CI 0.86-0.95]). GMA trajectories that combined abnormal writhing general movements at 4 to 5 weeks corrected age with suboptimal quality of fidgety movement at 16 weeks corrected age were strongly predictive of developmental delay, superior to all other clinical tools, and perinatal and demographic variables investigated (p=0.01, Akaike information criterion method 18.79 [score corrected for small sample size], accounting for 93% of the cumulative weight). Only the GMA had sufficient predictive validity to act as a biomarker for both conditions: typical outcome and developmental delay (motor or cognitive). GMA trajectories that assessed both writhing general movements at 4 to 5 weeks corrected age and quality of fidgety movement at 16 weeks corrected age predicted adverse neurodevelopmental outcome, accurately differentiating between infants with typical outcomes and those at increased risk for motor or cognitive delay.

How well does the General Movement Assessment predict general developmental delay in infants born very preterm/low birthweight?

How well does the General Movement Assessment predict general developmental delay in infants born very preterm/low birthweight?

General movements assessment and Alberta Infant Motor Scale in neurodevelopmental outcome of preterm infants.

We aimed to compare the General Movement Assessment (GMA) and the Alberta Infant Motor Scale (AIMS) in preterm infants for the prediction of cerebral palsy (CP) and neurodevelopmental delay (NDD). Additionally, we aimed to evaluate the diagnostic compatibility of the General Movement Optimality Score (GMOS), the Motor Optimality Score (MOS), and AIMS for detecting CP and NDD. Seventy-five preterm infants with gestational age (GA) 24-37 weeks were enrolled. Group 1 was composed of infants with 24-28GA (n=22); groups 2 and 3 consisted of infants with 29-32GA weeks (n=23) and 33-37GA (n=30) weeks, respectively. The infants were assessed during the writhing period, the fidgety period, and at 6-12 months of corrected age with GMOS, MOS, and AIMS, respectively. In the writhing period, a cramped-synchronized pattern was observed in 17 (22%) infants, whereas a poor repertoire pattern was observed in 34 (45%) infants. In the fidgety period of the 63 infants, 29 (46%) presented with fidgety movements absent. The MOS and AIMS scores of the infants in group 1 were significantly lower than the other groups, which were statistically significant (p=0.004, p˂0.001). High and positive compatibility (Kappa coefficient: 0.709; p=0.001) was found between AIMS and GMOS scores and between AIMS and MOS scores (Kappa coefficient: 0.804; p<0.001). In all groups, a statistically significant association was found between total GMOS scores (p=0.003) and the presence of fidgety movements (p=0.003). GMOS, MOS, and AIMS were found to be associated with CP and NDD (p<0.001). GMA is an important tool for the prediction of CP and NDD. The combined use of GMOS, MOS, and AIMS may guide the clinical practice for the valid and reliable diagnosis of CP and NDD.

Spontaneous Orofacial Movements at Writhing and Fidgety General Movements Age in Preterm and Full-Term Infants.

Background: As general spontaneous movements at the writhing and fidgety ages have been important for the early identification of neurodevelopmental impairment of both full-term and preterm infants, the knowledge of the spontaneous orofacial movements at these ages also seems to be important for the diagnosis of oral function, particularly in preterm infants. Therefore, we decided to first classify preterm and full-term infants according to general movements ages, and then to record, describe, compare, and discuss their spontaneous orofacial movements. Methods: This cross-sectional study included 51 preterm infants (born between 28 and 36 weeks) and 43 full-term infants who were classified at the writhing and fidgety ages of Prechtl’s method of general movements assessment. Their spontaneous orofacial movements were recorded on video, and The Observer XT software (Noldus) was used to record the quantitative values of the movements. Results: Poor repertoires of writhing movements were more frequent in the preterm infants (90.9%) compared to full-term ones (57.9%). Positive fidgety movements were observed in 100% of both preterm and full-term infants. Oral movements were similar for both preterm and full-term infants, regardless of their movement stage. Conclusion: All spontaneous orofacial movements were present both in preterm and full-term infants, albeit with higher frequency, intensity, and variability at fidgety age.

The trajectory of general movements from birth until 12 - 14 weeks corrected age in very low birthweight and extremely low-birthweight infants born preterm

&#x0D; Background. General movement assessment (GMA) is an assessment tool with high predictive validity for neurodevelopmental outcomes in preterm infants. Information available describing the trajectory of general movements (GMs) in high-risk preterm-born infants and the use thereof in low- and middle-income countries is limited.&#x0D; Objective. To describe the trajectories of GMs from birth until 12 - 14 weeks’ corrected age, and determine the association of known perinatal risk factors on GM trajectories in very low-birthweight and extremely low-birthweight preterm infants.&#x0D; Methods. This was a longitudinal, prospective cohort study with 119 preterm infants born at &lt;33 weeks’ gestation and with a birthweight &lt;1 500 g. GMs were recorded at four key age periods: 1 - 2 weeks after birth to 33 weeks post menstrual age (PMA); 34 - 37 weeks PMA; term equivalent age (TEA); and 12 - 14 weeks corrected age. Detailed perinatal data were collected.&#x0D; Results. A total of 300 GMAs were conducted, 157 during the preterm age, 55 during TEA and 88 at 12 - 14 weeks corrected age. At &lt;33 weeks PMA, 96% of GMs were abnormal and 4% normal. At 34 - 37 weeks PMA, 89% of GMs were abnormal and 11% normal. All GMs recorded at term equivalent age were abnormal. At 12 - 14 weeks corrected age, 7% of GMs were abnormal and 93% normal.&#x0D; Conclusion. GMs were predominantly abnormal prior to term with a significant decrease in abnormality at 12 - 14 weeks corrected age. Lower birthweight and lower PMA were associated with increased odds for abnormal GMs. In a resource-constrained environment, observing GMs at 12 - 14 weeks corrected age (during the fidgety period) is a time- and cost-effective method to determine the risk for adverse neurodevelopment.&#x0D;