Quality Of General Movements Research Articles

Does general movements quality in term infants predict cerebral palsy and milder forms of limited mobility at 6 years?

To evaluate in term infants associations between quality of general movements and developmental outcome in term infants at 6 years with either cerebral palsy (CP) or limited mobility without CP. Participants of this prospective study were 145 term infants (86 male, 59 female). Their general movements quality was assessed at 'writhing' and 'fidgety' general movements age (3wks and 13wks post term). The assessment at 6 years consisted of a neurological examination, including assessment of minor neurological dysfunction (MND), evaluation of mobility with the Movement Assessment Battery for Children, and of behaviour and learning problems with questionnaires. Definitely abnormal general movements at writhing age were not associated with CP, whereas definitely abnormal general movements at fidgety age were (sensitivity 60%; specificity 91%; positive predictive value 19%, negative predictive value 98%). In children without CP, general movements quality was not associated with limited mobility, but it was associated to a minor extent with MND. In term infants, definitely abnormal general movements at fidgety age do predict CP, but with lower accuracy than in preterm infants. General movements quality does not predict limited mobility in children without CP. The study supports suggestions that predictive value of general movements assessment in term infants is lower than that in preterm infants.

Characteristics of antigravity spontaneous movements in preterm infants up to 3 months of corrected age

AimsWe investigated whether spontaneous antigravity limbs movements in very low birth weight preterm infants were insufficient compared to those in term infants. The relationship between the quality of general movements (GMs) and antigravity limbs movements was also examined. MethodsPreterm infants with very low birth weight without central nervous system disorders nor severe respiration disorders, and healthy term infants were recruited. The infants were set in a supine position. The distance between both hands and between both feet, and the height of both hands and feet from the floor were recorded at 1–3 corrected months for preterm infants, and at 1–3 months for term infants by a 3D motion capture system. The measurements were adjusted for body proportions. GMs in preterm and term infants were assessed similarly. ResultsThirteen preterm and 15 term infants completed the study. In preterm infants, the distance between both hands and between both feet were longer, and the height of both hands and feet were lower than those in term infants in all measurements. In term infants, the height of both hands and feet increased as they developed, but no change was observed in preterm infants. In preterm infants with abnormal GMs, the distance between both hands was longer, and the height of both hands and feet was lower than that in those with normal GMs. There were no such differences between preterm infants with normal GMs and term infants with normal GMs. ConclusionAntigravity limbs movements in preterm infants within the first 3 month of corrected age were insufficient compared with those in term infants. Furthermore, no improvement with development was observed in preterm infants. In addition, preterm infants with abnormal GMs showed worse antigravity limbs movements than preterm and term infants with normal GMs. The preterm infants with normal GMs could behave similar to the full term infants.

Assessment of general movements and heart rate variability in prediction of neurodevelopmental outcome in preterm infants

BackgroundAdverse neurologic outcome in preterm infants could be associated with abnormal heart rate (HR) characteristics as well as with abnormal general movements (GMs) in the 1st month of life. AimsTo demonstrate to what extent GMs assessment can predict neurological outcome in preterm infants in our clinical setting; and to assess the clinical usefulness of time-domain indices of heart rate variability (HRV) in improving predictive value of poor repertoire (PR) GMs in writhing period. Study designQualitative assessment of GMs at 1 and 3 months corrected age; 24h electrocardiography (ECG) recordings and analyzing HRV at 1 month corrected age. SubjectsSeventy nine premature infants at risk of neurodevelopmental impairments were included prospectively. Outcome measuresNeurodevelopmental outcome was assessed at the age of 2 years corrected. Children were classified as having normal neurodevelopmental status, minor neurologic dysfunction (MND), or cerebral palsy (CP). ResultsWe found that GMs in writhing period (1 month corrected age) predicted CP at 2 years with sensitivity of 100%, and specificity of 72.1%. Our results demonstrated the excellent predictive value of cramped synchronized (CS) GMs, but not of PR pattern. Analyzing separately a group of infants with PR GMs we found significantly lower values of HRV parameters in infants who later developed CP or MND vs. infants with PR GMs who had normal outcome. ConclusionsThe quality of GMs was predictive for neurodevelopmental outcome at 2 years. Prediction of PR GMs was significantly enhanced with analyzing HRV parameters.

Knee jerk responses in infants at high risk for cerebral palsy: an observational EMG study.

Following our clinical observation of tonic responses in response to the knee jerk in infants at very high risk for cerebral palsy (VHR infants), we systematically studied tonic responses, clonus, and reflex irradiation. We questioned (i) whether these responses occurred more often in VHR infants than in typically developing (TD) infants, and (ii) whether they were associated with abnormal general movement quality. Twenty-four VHR and 26 TD infants were assessed around 3 mo corrected age. Surface electromyograms of leg, trunk, neck, and arm muscles were recorded while eliciting the knee jerk. All assessments were video-recorded. VHR infants more often than TD infants showed tonic responses in the ipsilateral quadriceps and hamstring (Mann-Whitney U; P = 0.0005 and P = 0.0009), clonus (Chi-square; P = 0.0005) and phasic responses in the contralateral quadriceps and hamstring (Mann-Whitney U; P = 0.002 and P = 0.0003, respectively). Widespread reflex irradiation occurred in VHR and TD infants. Definitely abnormal general movements and stiff movements were associated with tonic responses (Mann-Whitney U; P = 0.0005, P = 0.007, respectively) and clonus (Mann-Whitney U; P = 0.003 and P = 0.0005) in the ipsilateral quadriceps. Similar to clonus, tonic responses may be regarded as a marker of a loss of supraspinal control. Reflex irradiation primarily is a neurodevelopmental phenomenon of early ontogeny.

Specific characteristics of abnormal general movements are associated with functional outcome at school age

BackgroundAssessing the quality of general movements (GMs) is a non-invasive tool to identify at early age infants at risk for developmental disorders. AimTo investigate whether specific characteristics of definitely abnormal GMs are associated with developmental outcome at school age. Study designObservational cohort study (long-term follow-up). SubjectsParents of 40 children (median age 8.3years, 20 girls) participated in this follow-up study. In infancy (median corrected age 10weeks), the children (median gestational age 30.3weeks; birth weight 1243g) had shown definitely abnormal GMs according to Hadders-Algra (2004). Information on specific GM characteristics such as the presence of fidgety movements, degree of complexity and variation, and stiff movements, was available (see Hamer et al. 2011). Outcome measuresA standardised parental interview (presence of CP, attendance of school for special education, Vineland Adaptive Behavior Scale to determine functional performance) and questionnaires (Developmental Coordination Disorder Questionnaire [DCD-Q] to evaluate mobility and Child Behavior Checklist to assess behaviour) were used as outcome measures. ResultsSix children had cerebral palsy (CP), ten children attended a school for special education, and eight children had behavioural problems. Both the absence of fidgety movements and the presence of stiff movements were associated with CP (p=0.001; p=0.003, respectively). Stiff movements were also related to the need of special education (p=0.009). A lack of movement complexity and variation was associated with behavioural problems (p=0.007). None of the GM characteristics were related to DCD-Q scores. ConclusionsThe evaluation of fidgety movements and movement stiffness may increase the predictive power of definitely abnormal GMs for motor outcome — in particular CP. This study endorses the notion that the quality of GMs reflects the integrity of the infant's brain, assisting prediction of long-term outcome.

Posture and movement in very preterm infants at term age in and outside the nest

The objective of this study is to evaluate the use of nests on general movements (GM) and posture in very preterm infants at term age. Seventeen high-risk preterm infants-less than 30 weeks of gestation (GA)-underwent a video recording, lying in supine position, with or without nest. Posture, GM quality, and movements made around the child's midline, as well as abrupt movements and frozen postures-in extension or flexion of the four limbs-were analyzed. Nest did not modify quality of GM. Children significantly adopted a curled-up position. The nest system was associated with an increase in movements toward or across the midline, as well as reduction of the hyperextension posture and head rotation movements. Frozen postures in flexion or extension, as well as abrupt movements of the four limbs, were reduced but not significantly. Nest helps very preterm infants to adopt semi-flexed posture and facilitates movements across the midline and reduces movements of spine hyperextension, without GM global quality modifications.

Earlier diagnosis of neurodevelopmental disability can only help infants in neonatal intensive care units.

This commentary is on the original article by Einspieler et al. on pages 361–368 of this issue. Parents of infants in neonatal intensive care units (NICUs) are understandably concerned with their infant's development. As survival has markedly improved over the last two decades, the focus of health professionals has shifted to decreasing morbidity and improving neurodevelopmental outcomes. However, predicting development is challenging at an early age. Whilst traditional neurological assessments provide a profile of the neurological status of the infant, they often require prolonged handling that can be poorly tolerated by infants in the NICU and are less valuable in the accurate prediction of neurodevelopmental outcomes when performed before term age.1 The General Movements Trust has, for many decades, been a leader in attempting to predict outcome in an objective way. We know that the general movement assessment (GMA) is a validated non-invasive method to observe infants' spontaneous movements and is clinically feasible to use in a wide variety of infant populations: from extremely preterm infants to term infants recovering from major surgical procedures.2 The GMA, traditionally implemented in Europe, is gaining momentum in other countries, including Australia, with increasing numbers of certification courses run on a regular basis by the General Movements Trust. Repeated studies have shown the GMA to be predictive of later neurological outcome, particularly cerebral palsy (CP),3 with sensitivity and specificity rates that surpass those of traditional neurological assessment or magnetic resonance imaging.1 This data from Einspieler et al.4 adds to this knowledge by applying an important concept, namely optimality. The majority of studies that report on the GMA, use the global assessment categories when describing the quality of general movements; however, this study investigates and describes writhing general movements in more detail. Through further analysis and scoring of components such as amplitude, speed, and spatial range, a semi-quantification of the quality of movement can be achieved. By applying this to a large number of infants across varying preterm and term ages, the authors have been able to provide a rich description of movement characteristics within each global general movement category in the writhing period. This has particular significance for less experienced clinicians and could be used both as a complement to formal training, and in the clinical setting to improve reliability in GMA interpretation. Previous studies on the use of optimality scoring by this group and others have not been able to enhance the prediction of long-term outcome from that of the global GMA scores.5 However, the optimality score may have potential as a method to evaluate subtle change following early therapeutic interventions. Whilst more research is needed to investigate the effectiveness of early neonatal interventions such as providing an enriched environment or supporting infants through painful procedures, the use of assessments that allow the evaluation of these interventions is a step in the right direction. For parents, the GMA provides a chance for early intervention in infants considered ‘at risk’, rather than waiting for milestones to go unmet, or a formal label to be given. For conditions such as CP this is vital, as it allows the commencement of intensive early intervention, with promising research underway into goal and activity-based learning occurring within an enriched environment.6 Assessment tools with good predictive ability are of utmost importance within the clinical setting to identify infants at risk of poor neurodevelopmental outcomes and who may benefit from neuroregenerative therapies and targeted early intervention at the time of maximal neuroplasticity. The GMA is one such extremely promising tool. More studies are needed to investigate the application of detailed GMA using the optimality score across a wide range of infant populations and to determine the benefit in enhancing prediction of outcome. Important steps in the field of neonatology now are for more clinicians to complete the standardized training and certification process for the GMA, as a complement to existing neonatal assessment methods, and for the GMA to be routinely incorporated into infant follow-up.

Effect of (minor or major) maternal trauma on fetal motility: A prospective study

BackgroundFetal motility represents the spontaneous activity of the central nervous system and as such can be used to evaluate its functional integrity. Maternal mechanical trauma in pregnancy is a risk factor for hypoxic ischemic brain injury and can potentially affect the CNS and fetal motility. AimTo study motility in fetuses after maternal trauma. Study designProspective study; 1-h sonographic observations at 2–8h (T1), 24–72h (T2) and >72h (T3) after trauma. SubjectsFetuses exposed to trauma after 20weeks gestational age. Outcome measuresMotor aspects; differentiation into specific movement patterns, quality and quantity of general movements were compared to a normal population. Obstetrical outcome; neurological outcome at term and 1year of age. ResultsSixteen fetuses were examined between 2012 and 2014. Median gestational age at time of trauma was 25+6 (range 20–38) weeks. Most traumas were traffic accidents or falls, injuries were mainly minor. Motility assessment showed abnormal differentiation in 2/16; 2/14 and 0/16; abnormal quality in 2/16; 3/14 and 6/16; and abnormal quantity in 6/16, 9/14 and 9/16 at T1, T2 and T3 respectively. Preterm delivery occurred once. Neurological development was normal in 13/14 infants at term and 14/14 at one year. ConclusionsThis study shows that maternal trauma affected fetal motility in the majority of the fetuses. The changes in motility support the concern that even minor mechanical trauma may have influence on the functional integrity of the central nervous system, although no neurological sequelae were present at 1year.

P148 – 2593: How a single footage following Gestalt principles contributed to the diagnosis: A case study of a 5-year old girl with discrete dystonia and complex mutation of chromosome 18

Objective We present a 5-year old girl with mild developmental delay, short stature, stigmata dysplastica and strabism, who developed typically up to seventh month when growth and motor development slowed down. Year later squint was observed. At four years social functioning disorder was diagnosed, mainly due to speech delay. Laboratory and imaging results were not informative. General impression following the Gestalt principle led us to closer observation of a girl. Observation, documentation and assessment tool for babies' development was initiated by prof. Prechtl who described spontaneous movement, now called general movement (GM) in term babies and discovered that the quality of spontaneous general movements in the foetus and young infant could provide information on the integrity of the young nervous system. We have decided to use modified approach to the qualitative assessment of movements in our patient. Methods Short footage of girl's movement in our ambulatory unit showed discrete dystonic movements, which were not identified previously as well as inequivalent body scheme. The girl was sent for sensory-motor integration as well as further genetic work-up: kariotyping and FISH analysis. Results Filming enabled us to identify dystonia. Kariotyping showed two cell lines: 93% of all analysed cells showed isochromosome 18 (46,XX, i(18)(q10)); 7% of cells had 18p deletions (46,XX, del(18)(p11.1)). Kariotypes of both parents were normal. In both cell lines monosomy of short arm as well as trisomy of long arm of chromosome 18 were present. Dystonia is described as a rare feature of monosomy 18p. Conclusion In the presenting case, analysis of movement by filming revealed dystonia, which further guided diagnostic testing and treatment. By following consesus 2013 regarding dystonia we found a rare mutation which would not be detected otherwise. We present a 5-year old girl with mild developmental delay, short stature, stigmata dysplastica and strabism, who developed typically up to seventh month when growth and motor development slowed down. Year later squint was observed. At four years social functioning disorder was diagnosed, mainly due to speech delay. Laboratory and imaging results were not informative. General impression following the Gestalt principle led us to closer observation of a girl. Observation, documentation and assessment tool for babies' development was initiated by prof. Prechtl who described spontaneous movement, now called general movement (GM) in term babies and discovered that the quality of spontaneous general movements in the foetus and young infant could provide information on the integrity of the young nervous system. We have decided to use modified approach to the qualitative assessment of movements in our patient. Short footage of girl's movement in our ambulatory unit showed discrete dystonic movements, which were not identified previously as well as inequivalent body scheme. The girl was sent for sensory-motor integration as well as further genetic work-up: kariotyping and FISH analysis. Filming enabled us to identify dystonia. Kariotyping showed two cell lines: 93% of all analysed cells showed isochromosome 18 (46,XX, i(18)(q10)); 7% of cells had 18p deletions (46,XX, del(18)(p11.1)). Kariotypes of both parents were normal. In both cell lines monosomy of short arm as well as trisomy of long arm of chromosome 18 were present. Dystonia is described as a rare feature of monosomy 18p. In the presenting case, analysis of movement by filming revealed dystonia, which further guided diagnostic testing and treatment. By following consesus 2013 regarding dystonia we found a rare mutation which would not be detected otherwise.

PP02.9 – 2853: Neurological follow-up of infants exposed to maternal trauma in pregnancy

Objective Limited knowledge is available about neurodevelopmental outcome after intrauterine mechanical trauma exposure, although 7–8% of pregnancies are complicated by trauma. Guidelines advise hospital admission after trauma in pregnancy, which enabled a prospective evaluation of perinatal and neurological outcome. Examination of fetal motility facilitates assessment of the integrity of the central nervous system. We hypothesize a transient influence on fetal motility after maternal trauma and normal neurological development at one year in case of minor trauma. Methods Pregnant women admitted for trauma after 20 weeks gestational age (GA) between 2011 and 2014 were eligible. Cause of trauma and severity of injuries were analyzed. Three one-hour ultrasonographic observations were performed within 8 hours (T1), 24–72 hours (T2) and > 72 hours (T3) after trauma. Assessment of motility concerned differentiation into specific movement patterns, quality and quantity of general movements (normal values: de Vries et al, Early Hum Dev 1982 and 1988). Neurological examinations were performed at term equivalent age according to Prechtl and at 1 year according to Touwen and Alberta Infant Motor Scale. Results Sixteen women participated at a median GA of 25+6 (range 20–38) weeks. Most traumas were traffic accidents or falls and injuries were mainly minor. Motility assessment showed abnormal differentiation in 2/16; 2/14 and 0/16; abnormal quality in 2/16; 3/14 and 6/16; and abnormal quantity in 6/16, 9/14 and 9/16 at T1, T2 and T3 respectively. Neurological development at 0 and 1 year was normal in 15/16 and 13/13 respectively. Conclusion This preliminary evaluation shows that fetal motility was affected after maternal trauma in majority of the fetuses, however, not transiently in all within four days. The neurological outcome at 0 and 1 year was normal. The changes in motility support the concern that even minor mechanical trauma may have influence on the functional integrity of the central nervous system.

La motricité spontanée du nouveau-né comme outil diagnostique et son rôle dans la prise en charge précoce

The neurological assessment of the newborn infant is fundamental to early diagnosis and prognosis, intensive monitoring, and treatment programs. The clinician can take advantage of a wide range of protocols, the majority of which are based on muscular tone and reflexes, but active and spontaneous behavior is increasingly taken into account, proceeding from the seminal work done by Prechtl, Brazelton and other authors in the seventies and eighties. Prechtl's method on the assessment of General Movements (GMs) is a standardized protocol for the recording, observation and qualitative judgement of spontaneous motor activity, suitable for the preterm as well as the full-term newborn infant from the preterm period up to 24 weeks of post-term age. The method has a very high predictive value for the major disorders of motor development, in particular cerebral palsy, with both sensitivity and specificity above 90%. But GMs are also predictive for minor neurological, cognitive and relational disorders. Recently, tight and specific relationships have been shown between GMs quality and structural anomalies found on neonatal neuroimaging. The importance of GMs in clinical practice is not restricted to evaluation: this is an approach that teaches us to observe without excessive manipulation, to respect age-specific functional competences, to pay attention to spontaneous activity as a potential repertoire, from which the most effective patterns can be selected, reinforced and adapted.

PO-0861 The Quality Of General Movements During The Neonatal Period In Moderate And Late Preterm Infants

<h3>Objective</h3> The assessment of general movements (GMs) is a widely used technique to evaluate neurological (dys)function and to predict neurodevelopmental outcome in infants. De Vries and Bos (Early Hum Dev 2008, 2010) demonstrated that abnormal GMs are often seen in early recordings in extremely low birth weight (BW) and preterm (&lt; 32 weeks) infants. Aim of our study was to assess whether this finding could be replicated for moderate and late preterm infants (32/0–36/6 weeks’ gestation). <h3>Methods</h3> We assessed GMs during the first 2 weeks (Median = 7 days; 5–8 days) of 50 moderate and late preterm infants (31 males). GM quality (global and detailed scoring) was analysed off line and related to neonatal morbidity (mainly IRDS) and other clinical factors (birth weight, need for oxygen and intensive care). <h3>Results</h3> Mean gestational age (GA) of the infants was 35 weeks’ gestation (SD = 9 days); mean BW was 2207 grams (SD = 400). Abnormal GMs were observed in 23 infants: 19 poor repertoire, 2 infants cramped synchronised, and 2 chaotic. Yet another 10 infants were scored as normal but their detailed GM score revealed a reduced motor optimality. GM abnormalities were not related to perinatal factors, such as GA, birth weight or neonatal morbidity. <h3>Conclusion</h3> Almost every second infant had abnormal GMs during the first 2 weeks of life. Whether such an early and single GM assessment will be related to the neurodevelopmental outcome has still to remain open, as the individuals of our study group did not yet reach the age of an outcome assessment.

The Quality of General Movements after Treatment with Low-Dose Dexamethasone in Preterm Infants at Risk of Bronchopulmonary Dysplasia

Background: High-dose dexamethasone (DXM) treatment of preterms at risk of bronchopulmonary dysplasia leads to a deterioration in quality of their general movements (GMs). It is unknown whether low-dose DXM affects GM quality similarly. Objectives: To assess the effect of low-dose DXM treatment on the quality of GMs and fidgety GMs (FMs). Methods: A prospective study of preterms admitted to our NICU between 2010 and 2012, and treated with DXM (starting dose 0.25 mg/kg/day). We assessed GM/FM quality and calculated their motor optimality score (MOS) before, during, and after treatment up to 3 months postterm. Neurological follow-up was performed between 12 and 36 months. We related risk factors with infants' GM trajectories and MOSs. At 3 months we compared the MOSs of low-dose DXM infants and a historical cohort of infants treated with high-dose DXM or hydrocortisone. Results: 17 infants were included. GM/FM quality improved in 9 out of 13 initially abnormal infants (p = 0.004). Shorter periods of mechanical ventilation and higher birth weights were associated with better GM trajectories (p = 0.032 and p = 0.042, respectively). Infants starting treatment later had higher MOSs on day 7 (p = 0.047). Low-dose DXM infants had higher MOSs than high-dose DXM infants (β = -0.535; 95% CI -0.594 to -0.132; p = 0.003). Out of 17 infants, 2 died, 14 developed normally, and 1 developed with mild neurodevelopmental impairments. Infants whose GMs/FMs remained normal or improved had better outcomes than infants whose GMs/FMs remained abnormal (p = 0.019). Conclusions: Out of the 17 infants treated with low-dose DXM, 2 died. Of the surviving infants, neurological functioning improved with the majority having normal neurodevelopment at the age of 12-36 months.

Placental pathology and neurological morbidity in preterm infants during the first two weeks after birth

BackgroundThe placenta plays a crucial role during pregnancy and dysfunction causes long-term neurological problems. Identifying placenta-related risks for neurological problems shortly after birth may provide clues for early interventions aiming to improve neurological outcome. ObjectiveTo determine the association between placental pathology and neurological morbidity in preterm infants during the first two weeks after birth. Study designPlacentas of 52 singleton, preterm infants (GA: 25–31weeks, BW: 560–2250 grammes) were examined for histopathology. The infants' neurological condition shortly after birth was determined by assessing the quality of their general movements (GMs): normal, abnormal, or hypokinetic, on days 5, 8, and 15. A motor optimality score (MOS) was also assigned. ResultsExamination of the placentas revealed maternal vascular underperfusion (n=29), ascending intrauterine infection (AIUI) (n=19), villitis of unknown aetiology (n=6), chronic deciduitis (n=11), foetal thrombotic vasculopathy (FTV) (n=9), and elevated nucleated red blood cells (NRBCs) as a marker for foetal hypoxia (n=7). None of the placental lesions were significantly associated with the quality of GMs or MOS. ConclusionsThis study indicated that placental lesions were not associated with infants' neurological condition as measured by the quality of their general movements during the first two weeks after birth.

General movements in healthy full term infants during the first week after birth

BackgroundThe quality of general movements (GMs) is a widely used criterion to assess neurological dysfunction in young infants. It is unknown, however, whether the birth process influences the motor repertoire of healthy full term infants during the first week after birth. AimsTo assess the quality of GMs and to determine the motor optimality score (OS) in healthy full term infants during the first week after birth and to evaluate the influence of the mode of delivery on GM quality. Study designThirty-three healthy full term infants born either vaginally or after caesarean section (CS) under spinal anaesthesia were video recorded in the first week after birth in order to assess GM quality and to determine OS with Prechtl's method. ResultsAbnormal GMs were observed mainly on the early recordings: 86% on the day of birth (day 0), 94% on day 1, and 68% on day 2. On days 5 to 7 (day 5–7) all GMs were normal (P<.001). The OSs increased significantly from median 12 on day 0 to 18 on day 5–7 (P<.001). Monotonously slow movements were frequently seen during the first days but not on day 5–7 (P<.001). GM quality and OS did not differ between infants born by vaginal delivery or after CS under spinal anaesthesia. ConclusionsHealthy full term infants often showed abnormal GM quality and lower OSs during the first week after birth, irrespective of the mode of delivery. GM quality normalised during subsequent days and was normal on day 5–7.

Prognostic value of the qualitative assessments of general movements in late-preterm infants

BackgroundThe quality of general movements (GMs) and its predictive value have never been evaluated in late-preterm (LP) infants. AimsTo determine the characteristics of GMs and their predictive value for neurodevelopmental outcome in a cohort of infants born between 34 and 36weeks' gestation. Study design and subjects574 LP infants were examined using the standard methodological principles of Prechtl's method for assessing GMs both during writhing and fidgety periods. Outcome measuresInfants were assessed at 2years of age with neuromotor and developmental scales. ResultsA significant correlation was found between GMs and outcome both at writhing (rs 0.68; p<0.001) and at fidgety age (rs 0.78; p<0.001). The assessment at 1month showed 100% sensitivity and 86% specificity of predicting the development of cerebral palsy (CP), that at 3months was 100% sensitivity and 97% specificity. ConclusionsDuring the fidgety age GMs predict CP with very high sensitivity and specificity. The qualitative assessment of GMs should be employed to help identify LP infants who require early intervention for neurological abnormalities.

Early Neurological Outcome of Young Infants Exposed to Selective Serotonin Reuptake Inhibitors during Pregnancy: Results from the Observational SMOK Study

BackgroundUse of selective serotonin reuptake inhibitors (SSRI) during pregnancy is common while the effect on the infant’s neurological outcome is unknown. Our objective was to determine the effects of prenatal SSRI-exposure on the infants’ neurological functioning, adjusted for maternal mental health.MethodsA prospective observational study from May 2007 to April 2010. The study groups comprised 63 SSRI-exposed infants (SSRI group) and 44 non-exposed infants (non-SSRI group). Maternal depression and anxiety were measured using questionnaires. The main outcome measures during the first week after birth and at three to four months were the quality of the infants’ general movements (GMs) according to Prechtl and a detailed motor optimality score. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for abnormal GM quality in the SSRI and non-SSRI groups, and adjusted for maternal depression, anxiety, and other confounders. The study was registered under 53506435 in the ISRCTN.FindingsAll infants were born around term. During the first week, abnormal GMs occurred more frequently in the SSRI group than in the non-SSRI group (59% versus 33%) and the median MOS was lower (13 versus 18). The OR for abnormal GMs in the SSRI versus the non-SSRI group was 3·0 (95% CI, 1.3 to 6.9) and increased after adjustment for confounders. At three to four months, more SSRI-exposed infants had monotonous movements (48% versus 20%) with lower median MOSs (26 versus 28). The OR for monotonous movements was 3·5 (95% CI, 1.5 to 8.6) and increased after adjusting for confounders.InterpretationPrenatal exposure to SSRI had an adverse effect on early neurological functioning as reflected by GM quality, irrespective of maternal depression and anxiety, and other confounders. Physicians should take this into account in consultation with parents.

1256 Quality of General Movements After Treatment with Low-Dose Dexamethasone in Preterm Infants at Risk for Bronchopulmonary Dysplasia

BackgroundPostnatal dexamethasone (DXM) is widely used to treat preterm infants at risk for bronchopulmonary dysplasia. Previously, it was reported that high-dose DXM leads to deteriorated quality of general movements (GMs)....

Favorable Outcome in a Newborn With Molybdenum Cofactor Type A Deficiency Treated With cPMP

Molybdenum cofactor deficiency (MoCD) is a lethal autosomal recessive inborn error of metabolism with devastating neurologic manifestations. Currently, experimental treatment with cyclic pyranopterin monophosphate (cPMP) is available for patients with MoCD type A caused by a mutation in the MOCS-1 gene. Here we report the first case of an infant, prenatally diagnosed with MoCD type A, whom we started on treatment with cPMP 4 hours after birth. The most reliable method to evaluate neurologic functioning in early infancy is to assess the quality of general movements (GMs) and fidgety movements (FMs). After a brief period of seizures and cramped-synchronized GMs on the first day, our patient showed no further clinical signs of neurologic deterioration. Her quality of GMs was normal by the end of the first week. Rapid improvement of GM quality together with normal FMs at 3 months is highly predictive of normal neurologic outcome. We demonstrated that a daily cPMP dose of even 80 μg/kg in the first 12 days reduced the effects of neurodegenerative damage even when seizures and cramped-synchronized GMs were already present. We strongly recommend starting cPMP treatment as soon as possible after birth in infants diagnosed with MoCD type A.

637 Prenatal Exposure to Hydroxylated Polychlorinated Biphenyls is Associated with the Quality of the Motor Repertoire in Three-Month-Old Infants

Background and AimPolychlorinated biphenyls (PCBs) are ubiquitous environmental toxins, potentially toxic to the developing brain. Hydroxylated PCBs (OH-PCBs) are suggested to be even more toxic because of hydroxylation by the...