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

Abstract

Objective 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.

Study Design 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.

Results 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.

Conclusion 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.

Key Points

• 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.

Keywords

general movement assessment - very low birth weight infant - preterm infant - neonatal intensive care unit - implementation

Authors' Contributions

All authors contributed to revising the paper and approved of the final submitted version. Specifically, C.J.A. participated in the study design, data collection, data analysis, initial data interpretation, and draft of the first manuscript. L.C.L. participated in study design, data collection and interpretation, as well as provided critical feedback of manuscript drafts. E.A.C., N.L.K., and J.A.M. participated in writing the implementation guideline, data collection and interpretation, and provided feedback of manuscript drafts. S.A.Z. participated in initial concept, study design, data interpretation, critical review of manuscript drafts, and final edits of the manuscript.

Publikationsverlauf

Eingereicht: 05. Juni 2020

Angenommen: 22. Dezember 2020

Artikel online veröffentlicht:
03. Februar 2021

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