Predictive Value of Neurodevelopmental Assessment versus Evaluation of General Movements for Motor Outcome in Preterm Infants with Birth Weights <1500 g

Abstract

Purpose: The aim of this study was to make a comparison of predictive values of neurodevelopmental assessment and evaluation of videotaped spontaneous movements of premature infants for motor outcome.

Methods: We performed a prospective longitudinal study of 103 VLBW infants, 96 (455-1490 g, 24-35 weeks gestational age) including (a) a neurodevelopmental assessment based on criteria by Amiel-Tison/Grenier at 40 weeks postconceptional age, 3 and 20 months corrected age; (b) an evaluation of general movements with fidgety character, based on criteria by Prechtl, at 3 months; and (c) a standardized testing using the Griffiths Developmental Motor Scale at 20 months. We calculated sensitivity, specificity and predictive values for each method.

Results: For predicting motor outcome, the assessment of general movements (GM) had a positive predictive value of 89% and negative predictive value of 84%; neurodevelopmental assessment (NA) at 40 weeks had a positive predictive value of 33% and negative predictive value of 88%, respectively, with similar results for neurodevelopmental assessment at age 3 months.

Conclusions: Normal motor outcome of VLBW infants may be accurately predicted by clinical neurodevelopmental assessment, but for adverse outcomes, evaluation of general movements (fidgety movements) is superior. GM assessment has a high predictive value, especially for CP, but it needs to be complemented by NA for non-CP outcomes. It is a simple, repeatable and non-intrusive technique, and may be a valuable method for the early detection of central nervous system impairment in VLBW infants in routine follow-up.

Key words

Neurodevelopmental assessment - premature infants - cerebral palsy - fidgety movements

References

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1 Cramped-synchronized general movements (during preterm, term and early post-term age) appear rigid and lack normal smooth and fluent character. All limb and trunk muscles contract and relax almost simultaneously [18] [34].

2 Fidgety movements (seen at the earliest six weeks post-term and at the longest 20 weeks post-term) are circular movements of small amplitude, moderate speed and variable acceleration of neck, trunk, and limbs in all directions.

Correspondence