RESUMO
OBJECTIVE: To evaluate neuromotor repertoires and developmental milestones in infants exposed to antenatal COVID-19. DESIGN: Longitudinal cohort study. SETTING: Hospital-based study in Los Angeles, USA and Rio de Janeiro, Brazil between March 2020 and December 2021. PARTICIPANTS: Infants born to mothers with COVID-19 during pregnancy and prepandemic control infants from the Graz University Database. INTERVENTIONS: General movement assessment (GMA) videos between 3 and 5 months post-term age were collected and clinical assessments/developmental milestones evaluated at 6-8 months of age. Cases were matched by gestational age, gender and post-term age to prepandemic neurotypical unexposed controls from the database. MAIN OUTCOME MEASURES: Motor Optimality Scores Revised (MOS-R) at 3-5 months. Presence of developmental delay (DD) at 6-8 months. RESULTS: 239 infants were enrolled; 124 cases (83 in the USA/41 in Brazil) and 115 controls. GMA was assessed in 115 cases and 115 controls; 25% were preterm. Median MOS-R in cases was 23 (IQR 21-24, range 9-28) vs 25 (IQR 24-26, range 20-28) in controls, p<0.001. Sixteen infants (14%) had MOS-R scores <20 vs zero controls, p<0.001. At 6-8 months, 13 of 109 case infants (12%) failed to attain developmental milestones; all 115 control infants had normal development. The timing of maternal infection in pregnancy (first, second or third trimester) or COVID-19 disease severity (NIH categories asymptomatic, mild/moderate or severe/critical) was not associated with suboptimal MOS-R or DD. Maternal fever in pregnancy was associated with DD (OR 3.7; 95% CI 1.12 to 12.60) but not suboptimal MOS-R (OR 0.25; 95% CI 0.04 to 0.96). CONCLUSIONS: Compared with prepandemic controls, infants exposed to antenatal COVID-19 more frequently had suboptimal neuromotor development.
Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , Recém-Nascido , Lactente , Humanos , Gravidez , Feminino , Estudos de Coortes , Estudos Longitudinais , BrasilRESUMO
Abstract Objectives To develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score. Methods Three examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31-45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers' satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction). Results The scorers' satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p < 0.001). The checklist score also differentiated between poor-repertoire (median = 13) and cramped-synchronized general movements (median = 7; p = 0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal general movements was good to excellent (Kappa = 0.68-1.00); (ii) the distinction between the four general movement categories was considerable to excellent (Kappa = 0.56-0.93); (iii) the checklist was good to excellent (ICC = 0.77-0.96). Conclusion The general movement checklist proved an important tool for the evaluation of normal and abnormal general movements; its score may potentially document individual trajectories and the effect of therapeutic intervention.
Assuntos
Humanos , Masculino , Recém-Nascido , Lactente , Recém-Nascido Prematuro , Lista de Checagem , Satisfação Pessoal , MovimentoRESUMO
We report cognitive, language and motor neurodevelopment, assessed by the Bayley-III test, in 31 non-microcephalic children at age 3 with PCR-confirmed maternal Zika virus exposure (Rio de Janeiro, 2015-2016). Most children had average neurodevelopmental scores, however, 8 children (26%) presented delay in some domain. Language was the most affected: 7 children (22.6%) had a delay in this domain (2 presenting severe delay). Moderate delay was detected in the cognitive (3.2%) and motor (10%) domains. Maternal illness in the third trimester of pregnancy and later gestational age at birth were associated with higher Bayley-III scores. Zika-exposed children require long-term follow-up until school age.
Assuntos
Transtornos do Neurodesenvolvimento , Complicações Infecciosas na Gravidez , Infecção por Zika virus , Zika virus , Brasil , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Transtornos do Neurodesenvolvimento/etiologia , Gravidez , Infecção por Zika virus/epidemiologiaRESUMO
OBJECTIVES: To develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score. METHODS: Three examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31-45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers' satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction). RESULTS: The scorers' satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p<0.001). The checklist score also differentiated between poor-repertoire (median=13) and cramped-synchronized general movements (median=7; p=0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal general movements was good to excellent (Kappa=0.68-1.00); (ii) the distinction between the four general movement categories was considerable to excellent (Kappa=0.56-0.93); (iii) the checklist was good to excellent (ICC=0.77-0.96). CONCLUSION: The general movement checklist proved an important tool for the evaluation of normal and abnormal general movements; its score may potentially document individual trajectories and the effect of therapeutic intervention.
Assuntos
Lista de Checagem , Recém-Nascido Prematuro , Humanos , Lactente , Recém-Nascido , Masculino , Movimento , Satisfação PessoalRESUMO
ABSTRACT We report cognitive, language and motor neurodevelopment, assessed by the Bayley-III test, in 31 non-microcephalic children at age 3 with PCR-confirmed maternal Zika virus exposure (Rio de Janeiro, 2015-2016). Most children had average neurodevelopmental scores, however, 8 children (26%) presented delay in some domain. Language was the most affected: 7 children (22.6%) had a delay in this domain (2 presenting severe delay). Moderate delay was detected in the cognitive (3.2%) and motor (10%) domains. Maternal illness in the third trimester of pregnancy and later gestational age at birth were associated with higher Bayley-III scores. Zika-exposed children require long-term follow-up until school age.
Assuntos
Humanos , Feminino , Gravidez , Lactente , Pré-Escolar , Criança , Complicações Infecciosas na Gravidez , Transtornos do Neurodesenvolvimento/etiologia , Zika virus , Brasil , Infecção por Zika virus/enfermagemRESUMO
Importance: There is an urgent need to assess neurodevelopment in Zika virus (ZIKV)-exposed infants. Objectives: To perform general movement assessment (GMA) at 9 to 20 weeks' postterm age and to evaluate whether the findings are associated with neurodevelopmental outcomes at age 12 months in infants prenatally exposed to acute maternal illness with rash in Brazil during the ZIKV outbreak and in age-matched controls. Design, Setting, and Participants: In this cohort study, infants prenatally exposed to acute maternal illness with rash were recruited at medical institutions in Rio de Janeiro and Belo Horizonte, Brazil, from February 1, 2016, to April 30, 2017, while infants without any exposure to maternal illness originated from the Graz University Audiovisual Research Database for the Interdisciplinary Analysis of Neurodevelopment. Participants were 444 infants, including 76 infants without congenital microcephaly, 35 infants with microcephaly, and 333 neurotypical children matched for sex, gestational age at birth, and age at GMA. Main Outcomes and Measures: General movement assessment performed at 9 to 20 weeks' postterm age, with negative predictive value, positive predictive value, sensitivity, and specificity generated, as well as clinical, neurologic, and developmental status (Bayley Scales of Infant and Toddler Development, Third Edition [Bayley-III] scores) at age 12 months. Motor Optimality Scores were generated based on the overall quality of the motor repertoire. Adverse outcomes were defined as a Bayley-III score less than 2 SD in at least 1 domain, a score less than 1 SD in at least 2 domains, and/or atypical neurologic findings. Results: A total of 444 infants were enrolled, including 111 children prenatally exposed to a maternal illness with rash and 333 children without any prenatal exposure to maternal illness (57.7% male and mean [SD] age, 14 [2] weeks for both groups); 82.1% (46 of 56) of ZIKV-exposed infants without congenital microcephaly were healthy at age 12 months. Forty-four of 46 infants were correctly identified by GMA at 3 months, with a negative predictive value of 94% (95% CI, 85%-97%). Seven of 10 ZIKV-exposed children without microcephaly with adverse neurodevelopmental outcomes were identified by GMA. The GMA positive predictive value was 78% (95% CI, 46%-94%), sensitivity was 70% (95% CI, 35%-93%), specificity was 96% (95% CI, 85%-99%), and accuracy was 91% (95% CI, 80%-97%). Children with microcephaly had bilateral spastic cerebral palsy; none had normal movements. The Motor Optimality Score differentiated outcomes: the median Motor Optimality Score was 23 (interquartile range [IQR], 21-26) in children with normal development, 12 (IQR, 8-19) in children with adverse outcomes, and 5 (IQR, 5-6) in children with microcephaly, a significant difference (P = .001). Conclusions and Relevance: This study suggests that although a large proportion of ZIKV-exposed infants without microcephaly develop normally, many do not. The GMA should be incorporated into routine infant assessments to enable early entry into targeted treatment programs.
Assuntos
Deficiências do Desenvolvimento/diagnóstico , Exame Físico/métodos , Complicações Infecciosas na Gravidez , Efeitos Tardios da Exposição Pré-Natal , Infecção por Zika virus/complicações , Brasil/epidemiologia , Desenvolvimento Infantil , Surtos de Doenças , Feminino , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas , Masculino , Microcefalia/virologia , Movimento , Exame Neurológico , Valor Preditivo dos Testes , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Infecção por Zika virus/epidemiologiaAssuntos
Encéfalo/diagnóstico por imagem , Desenvolvimento Infantil , Infecção por Zika virus , Brasil , Linguagem Infantil , Cognição , Deficiências do Desenvolvimento/virologia , Feminino , Humanos , Lactente , Estudos Longitudinais , Neuroimagem , Testes Neuropsicológicos , Gravidez , Complicações Infecciosas na Gravidez , Zika virus , Infecção por Zika virus/congênitoRESUMO
Abnormal general movements are among the most reliable markers for cerebral palsy. General movements are part of the spontaneous motor repertoire and are present from early fetal life until the end of the first half year after term. In addition to its high sensitivity (98%) and specificity (91%), the assessment of general movements is non-invasive and time- and cost-efficient. It is therefore ideal for assessing the integrity of the young nervous system, most notably in lowresource settings. Studies on the general movements assessment in low- and middle-income countries such as China, India, Iran, or South Africa are still rare but increasing. In Brazil, too, researchers have demonstrated that the evaluation of general movements adds to the functional assessment of the young nervous system. Applying general movements assessment in vulnerable populations in Brazil is therefore highly recommended.
Assuntos
Paralisia Cerebral/diagnóstico , Desenvolvimento Infantil , Destreza Motora , Exame Neurológico/métodos , Transtornos Psicomotores/diagnóstico , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Movimento , Variações Dependentes do Observador , Sensibilidade e EspecificidadeRESUMO
ABSTRACT Abnormal general movements are among the most reliable markers for cerebral palsy. General movements are part of the spontaneous motor repertoire and are present from early fetal life until the end of the first half year after term. In addition to its high sensitivity (98%) and specificity (91%), the assessment of general movements is non-invasive and time- and cost-efficient. It is therefore ideal for assessing the integrity of the young nervous system, most notably in lowresource settings. Studies on the general movements assessment in low- and middle-income countries such as China, India, Iran, or South Africa are still rare but increasing. In Brazil, too, researchers have demonstrated that the evaluation of general movements adds to the functional assessment of the young nervous system. Applying general movements assessment in vulnerable populations in Brazil is therefore highly recommended.
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Transtornos Psicomotores/diagnóstico , Paralisia Cerebral/diagnóstico , Desenvolvimento Infantil , Destreza Motora , Exame Neurológico/métodos , Variações Dependentes do Observador , Sensibilidade e Especificidade , MovimentoRESUMO
BACKGROUND: Even though Down syndrome is the most common chromosomal cause of intellectual disability, studies on early development are scarce. AIM: To describe movements and postures in 3- to 5-month-old infants with Down syndrome and assess the relation between pre- and perinatal risk factors and the eventual motor performance. METHODS AND PROCEDURES: Exploratory study; 47 infants with Down syndrome (26 males, 27 infants born preterm, 22 infants with congenital heart disease) were videoed at 10-19 weeks post-term (median=14 weeks). We assessed their Motor Optimality Score (MOS) based on postures and movements (including fidgety movements) and compared it to that of 47 infants later diagnosed with cerebral palsy and 47 infants with a normal neurological outcome, matched for gestational and recording ages. OUTCOMES AND RESULTS: The MOS (median=13, range 10-28) was significantly lower than in infants with a normal neurological outcome (median=26), but higher than in infants later diagnosed with cerebral palsy (median=6). Fourteen infants with Down syndrome showed normal fidgety movements, 13 no fidgety movements, and 20 exaggerated, too fast or too slow fidgety movements. A lack of movements to the midline and several atypical postures were observed. Neither preterm birth nor congenital heart disease was related to aberrant fidgety movements or reduced MOS. CONCLUSIONS AND IMPLICATIONS: The heterogeneity in fidgety movements and MOS add to an understanding of the large variability of the early phenotype of Down syndrome. Studies on the predictive values of the early spontaneous motor repertoire, especially for the cognitive outcome, are warranted. WHAT THIS PAPER ADDS: The significance of this exploratory study lies in its minute description of the motor repertoire of infants with Down syndrome aged 3-5 months. Thirty percent of infants with Down syndrome showed age-specific normal fidgety movements. The rate of abnormal fidgety movements (large amplitude, high/slow speed) or a lack of fidgety movements was exceedingly high. The motor optimality score of infants with Down syndrome was lower than in infants with normal neurological outcome but higher than in infants who were later diagnosed with cerebral palsy. Neither preterm birth nor congenital heart disease were related to the motor performance at 3-5 months.
Assuntos
Síndrome de Down , Atividade Motora/fisiologia , Movimento/fisiologia , Postura/fisiologia , Desempenho Psicomotor , Avaliação da Deficiência , Síndrome de Down/diagnóstico , Síndrome de Down/fisiopatologia , Feminino , Idade Gestacional , Humanos , Lactente , Masculino , Exame Neurológico/métodos , Avaliação de Resultados da Assistência ao Paciente , Fatores de Risco , Estatística como AssuntoRESUMO
Newborns are born into a social environment that dynamically responds to them. Newborn behaviors may not have explicit social intentions but will nonetheless affect the environment. Parents contingently respond to their child, enabling newborns to learn about the consequences of their behaviors and encouraging the behavior itself. Consequently, newborn behaviors may serve both biological and social-cognitive purposes during development.
Assuntos
Meio Social , Fala , Criança , Humanos , Recém-Nascido , Intenção , Relações Interpessoais , Comportamento SocialRESUMO
Abstract Objectives: To describe fidgety movements (FMs), i.e., the spontaneous movement pattern that typically occurs at 3–5 months after term age, and discuss its clinical relevance. Sources: A comprehensive literature search was performed using the following databases: MEDLINE/PubMed, CINAHL, The Cochrane Library, Science Direct, PsycINFO, and EMBASE. The search strategy included the MeSH terms and search strings (‘fidgety movement*’) OR [(‘general movement*’) AND (‘three month*’) OR (‘3 month*’)], as well as studies published on the General Movements Trust website (www.general-movements-trust.info). Summary of the data: Virtually all infants develop normally if FMs are present and normal, even if their brain ultrasound findings and/or clinical histories indicate a disposition to later neurological deficits. Conversely, almost all infants who never develop FMs have a high risk for neurological deficits such as cerebral palsy, and for genetic disorders with a late onset. If FMs are normal but concurrent postural patterns are not age-adequate or the overall movement character is monotonous, cognitive and/or language skills at school age will be suboptimal. Abnormal FMs are unspecific and have a low predictive power, but occur exceedingly in infants later diagnosed with autism. Conclusions: Abnormal, absent, or sporadic FMs indicate an increased risk for later neurological dysfunction, whereas normal FMs are highly predictive of normal development, especially if they co-occur with other smooth and fluent movements. Early recognition of neurological signs facilitates early intervention. It is important to re-assure parents of infants with clinical risk factors that the neurological outcome will be adequate if FMs develop normally.
Resumo Objetivos: Descrever os movimentos irregulares (FMs), ou seja, o padrão de movimentos espontâneos que normalmente ocorrem entre três e cinco meses após o nascimento e discutir sua relevância clínica. Fontes: Uma pesquisa abrangente na literatura foi feita nas seguintes bases de dados: Medline/PubMed, Cinahl, The Cochrane Library, Science Direct, PsycINFO e Embase. A estratégia de busca incluiu os termos e cadeias de pesquisa do MeSH [(“fidgety movement*”) OU [(“general movement*”) E (“three month*”) OU (“3 month*”)], bem como estudos publicados no website da General Movements Trust (www.general-movements-trust.info). Resumo dos dados: Praticamente todos os neonatos se desenvolveram normalmente se os FMs estiveram presentes e foram normais, mesmo se seus resultados do ultrassom do cérebro e/ou históricos clínicos indicassem tendência a déficits neurológicos posteriores. Por outro lado, quase todos os neonatos que nunca desenvolveram FMs apresentaram maior risco de déficits neurológicos, como paralisia cerebral, e doenças genéticas de início tardio. Caso os FMs fossem normais, porém simultâneos a padrões posturais não adequados para a idade, ou o caráter geral dos movimentos fosse monótono, as capacidades cognitivas e/ou de linguagem na idade escolar seriam abaixo do ideal. Os FMs anormais não são específicos e têm baixo poder preditivo, porém ocorrem em grande parte em neonatos posteriormente diagnosticados com autismo. Conclusões: FMs anormais, ausentes ou esporádicos indicam um risco maior de disfunções neurológicas posteriores, ao passo que FMs normais são altamente preditivos de desenvolvimento normal, principalmente se forem simultâneos a outros movimentos suaves e fluentes. O reconhecimento precoce de sinais neurológicos facilita a intervenção antecipada. É importante garantir aos pais de neonatos com fatores de risco clínicos que o resultado neurológico será adequado se os FMs se desenvolverem normalmente.
Assuntos
Humanos , Recém-Nascido , Lactente , Comportamento do Lactente/fisiologia , Atividade Motora/fisiologia , Transtornos dos Movimentos/fisiopatologia , Fatores de Tempo , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Fatores Etários , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/etiologia , Exame NeurológicoRESUMO
BACKGROUND: Zika virus (ZIKV) has been linked to central nervous system malformations in fetuses. To characterize the spectrum of ZIKV disease in pregnant women and infants, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in infants. METHODS: We enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase-polymerase-chain-reaction assays. We followed women prospectively to obtain data on pregnancy and infant outcomes. RESULTS: A total of 345 women were enrolled from September 2015 through May 2016; of these, 182 women (53%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 6 to 39 weeks of gestation. Predominant maternal clinical features included a pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 27% had fever (short-term and low-grade). By July 2016, a total of 134 ZIKV-affected pregnancies and 73 ZIKV-unaffected pregnancies had reached completion, with outcomes known for 125 ZIKV-affected and 61 ZIKV-unaffected pregnancies. Infection with chikungunya virus was identified in 42% of women without ZIKV infection versus 3% of women with ZIKV infection (P<0.001). Rates of fetal death were 7% in both groups; overall adverse outcomes were 46% among offspring of ZIKV-positive women versus 11.5% among offspring of ZIKV-negative women (P<0.001). Among 117 live infants born to 116 ZIKV-positive women, 42% were found to have grossly abnormal clinical or brain imaging findings or both, including 4 infants with microcephaly. Adverse outcomes were noted regardless of the trimester during which the women were infected with ZIKV (55% of pregnancies had adverse outcomes after maternal infection in the first trimester, 52% after infection in the second trimester, and 29% after infection in the third trimester). CONCLUSIONS: Despite mild clinical symptoms in the mother, ZIKV infection during pregnancy is deleterious to the fetus and is associated with fetal death, fetal growth restriction, and a spectrum of central nervous system abnormalities. (Funded by Ministério da Saúde do Brasil and others.).
Assuntos
Sistema Nervoso Central/anormalidades , Morte Fetal , Retardo do Crescimento Fetal/virologia , Microcefalia/virologia , Complicações Infecciosas na Gravidez , Infecção por Zika virus/complicações , Zika virus/isolamento & purificação , Adolescente , Adulto , Encéfalo/anormalidades , Brasil/epidemiologia , Sistema Nervoso Central/embriologia , Feminino , Morte Fetal/etiologia , Retardo do Crescimento Fetal/epidemiologia , Feto/anormalidades , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Gravidez , Nascimento Prematuro/epidemiologia , Ultrassonografia Pré-Natal , Adulto JovemRESUMO
OBJECTIVES: To describe fidgety movements (FMs), i.e., the spontaneous movement pattern that typically occurs at 3-5 months after term age, and discuss its clinical relevance. SOURCES: A comprehensive literature search was performed using the following databases: MEDLINE/PubMed, CINAHL, The Cochrane Library, Science Direct, PsycINFO, and EMBASE. The search strategy included the MeSH terms and search strings ('fidgety movement*') OR [('general movement*') AND ('three month*') OR ('3 month*')], as well as studies published on the General Movements Trust website (www.general-movements-trust.info). SUMMARY OF THE DATA: Virtually all infants develop normally if FMs are present and normal, even if their brain ultrasound findings and/or clinical histories indicate a disposition to later neurological deficits. Conversely, almost all infants who never develop FMs have a high risk for neurological deficits such as cerebral palsy, and for genetic disorders with a late onset. If FMs are normal but concurrent postural patterns are not age-adequate or the overall movement character is monotonous, cognitive and/or language skills at school age will be suboptimal. Abnormal FMs are unspecific and have a low predictive power, but occur exceedingly in infants later diagnosed with autism. CONCLUSIONS: Abnormal, absent, or sporadic FMs indicate an increased risk for later neurological dysfunction, whereas normal FMs are highly predictive of normal development, especially if they co-occur with other smooth and fluent movements. Early recognition of neurological signs facilitates early intervention. It is important to re-assure parents of infants with clinical risk factors that the neurological outcome will be adequate if FMs develop normally.
Assuntos
Comportamento do Lactente/fisiologia , Atividade Motora/fisiologia , Transtornos dos Movimentos/fisiopatologia , Fatores Etários , Paralisia Cerebral/diagnóstico , Paralisia Cerebral/fisiopatologia , Humanos , Lactente , Recém-Nascido , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/etiologia , Exame Neurológico , Valor Preditivo dos Testes , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: It continues to be a challenge for clinicians to identify preterm infants likely to experience subsequent neurodevelopmental deficits. The Test of Infant Motor Performance (TIMP) and the assessment of spontaneous general movements (GMs) are the only reliable diagnostic and predictive tools for the functionality of the developing nervous system, if applied before term. AIM: To determine to what extent singular preterm assessments of motor performance can predict the neurodevelopmental outcome in 14-month olds. METHODS: Thirty-seven preterm infants born <34weeks gestational age were recruited for the study at the NICU of the São Lucas University Hospital, Porto Alegre, RS, Brazil. At 34weeks, their GMs were assessed; and the Test of Infant Motor Performance (TIMP) was applied. A prospective design was used to examine (A) the association between the GM assessment and the TIMP; and (B) the relation between GMs or the TIMP and the developmental status at 14months, assessed by means of Alberta Infant Motor Scales (AIMS) and the Pediatric Evaluation of Disability Inventory (PEDI). RESULTS: Nineteen infants (41%) had abnormal GMs; only one scored within the TIMP average range. Hence, GMs and TIMP were not related. Children with cramped-synchronized GMs at 34weeks preterm had a lower AIMS centile rank than those with poor repertoire or normal GMs. There was a marginal association between cramped-synchronized GMs and a lower PEDI mobility score. CONCLUSIONS: A single preterm GM assessment is only fairly to moderately associated with the 14-month motor development. The TIMP is not suitable as a complementary assessment tool at such a young age.
Assuntos
Doenças do Prematuro/diagnóstico , Transtornos dos Movimentos/diagnóstico , Movimento/fisiologia , Doenças do Sistema Nervoso/diagnóstico , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Exame Neurológico/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Desempenho Psicomotor , Reprodutibilidade dos Testes , Fatores de RiscoRESUMO
OBJECTIVE: The quality of a child's motor repertoire at age 3 to 4 months postterm is predictive of later cerebral palsy (CP). Its predictive power for minor neurologic dysfunction (MND) is unclear. This study aimed to investigate the predictive value of the quality of the early motor repertoire for the development of MND at school age. STUDY DESIGN: We assessed the motor repertoire from video recordings made at 6 to 24 weeks postterm in 82 preterm infants (mean gestational age, 29.7 +/- 1.9 weeks; mean birth weight, 1183 +/- 302 g). At age 7 to 11 years, Touwen's neurologic examination was performed, and the children were classified as normal (n = 49; 60%), MND (n = 18; 22%), or CP (n = 15; 18%). RESULTS: Multiple logistic regression analysis showed that the quality of fidgety movements (FMs) and the quality of the concurrent motor repertoire had independent prognostic value for MND at school age. Abnormal FMs evolved into MND in 64% of the children. Nine of the 28 children with normal FMs and an abnormal concurrent motor repertoire developed abnormally (32%). Only 1 child of the 21 children with normal FMs and a normal concurrent motor repertoire developed MND (5%). CONCLUSIONS: Assessment of the quality of the early motor repertoire can accurately identify individual infants at high and low risk for MND at school age.