Unterschiede in der Verteilung der General Movements-Klassifikation zwischen neonatalen Risikogruppen im Kinderspital Zürich: Eine Beobachtungsstudie

Zusammenfassung

Einleitung Kinder auf der Neonatologie weisen ein erhöhtes Risiko für motorische Entwicklungsstörungen auf.

Ziel Vergleich der General Movements (GMs)-Klassifikation zwischen drei neonatalen Risikogruppen, Korrelation des GMs-Assessment (GMA) mit einer standardisierten, entwicklungsneurologischen Untersuchung (SENU) sowie Bestimmung von Risikofaktoren für abnormale GMs.

Methodik Monozentrische Beobachtungsstudie mit drei Risikogruppen (Kinder mit operierten, angeborenen Herzfehlern (aHF) n=26, mit operierten, angeborenen, gastrointestinalen Fehlbildungen (GIF) n=17 und mit fetal operierter Myelomeningozele (MMC) n=12, die stationär videobasiert untersucht wurden. Das GMA wurde gemäss Klassifikation nach Hadders-Algra bewertet und in 4 Kategorien eingeteilt: normal optimal (NO), normal suboptimal (NS), leicht abnormal (LA), deutlich abnormal (DA).

Ergebnisse Es zeigte sich folgende Verteilung: aHF 80,8% NS, 19,2% LA, GIF 5,9% NO, 64,7% NS, 29,4% LA, MMC obere Extremitäten 100% NS, untere Extremitäten 33,3% NS, 33,3% LA und 33,3% DA (Gruppenvergleich Kruskal-Wallis 10 729, p=0,003). Das GMA korrelierte signifikant mit der SENU (Spearman rs=0,869, p<0,001). Die binär logistische Regressionsanalyse zeigte, dass nur das Gestationsalter (Chi2=11,93, p<0,001) mit abnormalen GMs korrelierte.

Schlussfolgerung Die Mehrheit der Kinder zeigte normale GMs. Kinder mit MMC und solche mit tieferem Gestationsalter wiesen ein erhöhtes Risiko für abnormale GMs auf. Das GMA und die SENU stellen ergänzende «bedside tools» dar, um früh motorische Auffälligkeiten zu erkennen.

Abstract

Introduction Neonatal infants are at increased risk for motor development disorders.

Objective To compare General Movements (GMs) classification between three neonatal risk groups, correlate the GMs Assessment (GMA) with a standardized developmental neurological examination (SDNE) and determine risk factors for abnormal GMs.

Methods Monocentric observational study with three risk groups (children with operated congenital heart disease (CHD) n=26, with operated congenital gastrointestinal malformations (CGM) n=17 and with fetal operated myelomeningocele (MMC) n=12 who underwent inpatient video-based examination. GMA was evaluated according to Hadders-Algra classification and divided into 4 categories: normal optimal (NO), normal suboptimal (NS), mildly abnormal (MA), definitely abnormal (DA).

Results The distribution was as follows: CHD 80.8% NS, 19.2% MA, CGM 5.9% NO, 64.7% NS, 29.4% MA, MMC upper extremities 100% NS, lower extremities 33.3% NS, 33.3% MA and 33.3% DA (group comparison Kruskal-Wallis 10.729, p=0.003). GMA correlated significantly with SDNE (Spearman r _s=0.869, p<0.001). Binary logistic regression analysis showed that only gestational age (Chi²=11.93, p<0.001) correlated with abnormal GMs.

Conclusion The majority of children showed normal GMs. Children with MMC and those with lower gestational age showed an increased risk of abnormal GMs. The GMA and SDNE represent complementary “bedside tools” to detect early motor abnormalities.

Schlüsselwörter

General Movements-Assessment - Herzfehler - gastrointestinale Fehlbildungen - MMC

Key words

General movements assessment - congenital heart disease - gastrointestinal malformations - MMC

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