Clinical factors associated with abnormal general movements of preterm newborns during hospitalization in a neonatal intensive care unit

General movement assessments in neonates born with congenital gastrointestinal anomalies: a single site, retrospective study

OBJECTIVE

We aimed to characterize general movements in neonates with congenital gastrointestinal anomalies and to compare them to general movements in extremely low birth weight (ELBW) infants.

STUDY DESIGN

This was a retrospective, single-site study. Subjects were divided into two groups: those with gastrointestinal (GI) anomalies and ELBW infants (birth weight <1 kg). The primary outcome was general movement assessments.

RESULT

Ninety-six infants were included (n = 51, GI group and n = 45, ELBW group). The rates of abnormal general movements between the groups were comparable (writhing movements: 61% vs. 59%, p = 0.89; fidgety movements: 20% vs. 36%, p = 0.13). Writhing movements were different (100% poor repertoire, 0% cramped synchronous in the GI group vs. 50% poor repertoire and 50% cramped synchronous in the ELBW group, p < 0.001).

CONCLUSION

Infants with gastrointestinal anomalies are at risk for abnormal general movements. Abnormal fidgety general movements may be an early biomarker for future motor deficits.

Writhing Movements and Hypoglycemia in Moderate-Late Preterm Infants: A Prospective Cohort Study

Introduction: This study aims to examine the relationship between hypoglycemia and general movement patterns during the early post-term-aged in moderate-to-late preterm infants and to assess the interobserver reliability of movement evaluation during this period. Compared with full-term infants, moderate-to-late preterm infants constitute the largest group of premature births globally and are at greater risk of developing neurodevelopmental disorders. Hypoglycemia is one of the most prevalent risk factors in this group. Methods: This prospective single-center explorative cohort study included moderate-to-late preterm infants during their admission in the neonatal intensive care unit. General movements were assessed via Prechtl's General Movements Assessment, and blood glucose levels were monitored via the FreeStyle Optium™ Neo glucometer. Associations were analyzed via Fisher's exact test, whereas interobserver reliability was evaluated via the intraclass correlation coefficient (ICC) and the kappa coefficient. Results: A total of 17 moderate-to-late preterm infants with hypoglycemia (<45 mg/dL) presented a relatively high percentage (58.8%) of poor repertoire and normal (35.2%) general movement patterns during the early post-term-aged. Interobserver reliability was good (ICC = 0.7), and the kappa coefficient indicated moderate reliability (0.4). Conclusions: Moderate-to-late preterm infants with transient hypoglycemia may frequently display poor repertoire movement patterns, highlighting the need for careful monitoring. Furthermore, the evaluation of general movements proves to be a reliable tool during the early post-term-aged.

Effects of mechanical ventilation on neurodevelopment at 12 months in preterm low birth weight pediatric patients: a systematic review

Introduction

The objective of this review is to know the existing scientific evidence about the effects of mechanical ventilation (MV) on neurological development in low-birth-weight premature pediatric patients after 12 months of life, taking as background the direct impact that ventilation has on the central nervous system in the newborn during the first days of life.

Methods

A systematic search was carried out between 2003 and 2024 in the data bases of: PUBMED, Cochrane Library Plus, PEDro, CINAHL, and SciELO, and two investigators scored the articles according to the Newcastle-Ottawa Assessment scale.

Results

Were found 129 non-replicated articles, and 10 cohort and cross-sectional studies were selected that performed an assessment of neurodevelopment in the three spheres after 12 months of life in corrected age of premature infants exposed to ventilator support and related the two variables independently.

Conclusions

Mechanical ventilation is an independent neurodevelopmental risk factor in low-birth-weight preterm infants. The time of exposure and the type of ventilation were the variables with the most scientific evidence.

Systematic Review Registration

https://www.crd.york.ac.uk/, Identifier CRD42023446797.

Clinical Factors Related to Abnormal General Movements Trajectories: Development of a Multicriteria Index

PURPOSE

To create a multicriteria index with clinical factors associated with abnormal general movements (GMs) trajectories during a stay in the neonatal intensive care unit.

METHODS

A longitudinal study assessed abnormal GMs trajectories in preterm infants in the neonatal intensive care unit. The multicriteria index included clinical factors such as intraventricular hemorrhage, respiratory support, gestational age, patent ductus arteriosus, and infection based on multi-attribute utility theory.

RESULTS

A total of 52 preterm newborns, 57.7% male, were evaluated. The multicriteria index correlated with abnormal GMs trajectories and explained 26.5% of the variance in these trajectories.

CONCLUSION

The developed multicriteria index, with the inclusion of combined clinical factors, allowed the identification of part of the abnormal trajectories of GMs in preterm infants. The multicriteria analysis can help clinicians to identify infants who have a greater chance of poor developmental trajectories before hospital discharge.

Intrauterine twin environment and genetic factors subliminally affecting general movements in preterm infants

BACKGROUND

Understanding background factors is beneficial for interpreting general movements (GMs). This study examines the factors involved in preterm-writhing GMs by comparing twins and singletons.

METHOD

The subjects were 107 infants cared for at Oita University. The cohort consisted of very-low-birth-weight infants, including twins with a birth weight < 2000 g. The median gestational age (GA) was 29 weeks 1 day. The subjects consisted of 75 singletons, 32 twins (16 pairs), 20 monochorionic twins (M-twins), and 12 dichorionic twins (D-twins). GMs were scored according to the GMs optimality score (GMOS) and integrated into 6 items: the quality, neck-trunk and space, amplitude-speed, rotation, onset-offset and cramped, and tremulous score at 32-34 weeks, 35-36 weeks, and 37-42 weeks' GA. A hierarchical cluster analysis was performed using integrated GMOS, and the characteristics of clusters were examined according to clinical backgrounds.

RESULTS

Three clusters were identified. Cluster 1 was characterized by good-quality GMs, cluster 2 by a poor repertoire but optimal space and rotatory components, and cluster 3 by overall poor-quality GMs, respectively. The mean GMOSs were 36.6, 31.8 and 24.3 in clusters 1, 2, and 3, respectively. There were no marked differences in proportions within clusters with respect to sex and twins. Small-for-gestational age (SGA) was significantly more frequent in cluster 3 at 32-34 weeks' GA than in other clusters. Perinatal brain injury had a significantly lower proportion in cluster 1 and a higher proportion in cluster 3 at 35-36 weeks' GA and 37-42 weeks' GA. M-twin pairs tended to belong to the same clusters at 35-36 weeks' GA.

CONCLUSION

Preterm writhing GMs are associated with SGA and perinatal brain injury. Cluster matching in M-twins suggests that certain genetic factors may substantially influence GMs.

Hybrid developmental follow-up for preterm infants in Brazil: A feasibility study

INTRODUCTION

The low attendance of families in child developmental follow-up programs for at-risk preterm children is a challenge in Brazil.

OBJECTIVE

This study evaluates the feasibility of implementing a developmental follow-up program for Brazilian preterm infants in a hybrid format.

METHODS

This is an observational, prospective cohort study, involving preterm infants. Longitudinal developmental test results, the participation frequency in the program, and the number of referrals to early intervention programs were used to assess feasibility. The General Movements (GMs) assessment, Alberta Infant Motor Scale (AIMS) and, Survey of Wellbeing of Young Children (SWYC) Milestones were administered via telehealth. The Bayley-III was administered in-person.

RESULTS

Thirty-four preterm infants attended the follow-up until 12 months of corrected age and 18 (52.9 %) concluded all follow-up assessments. Twenty-six (76.5 %) attended all assessments via telehealth, and 26 (76.5 %) attended the in-person assessment. Eighteen (52.9 %) infants showed at least one altered result in development tests. Infants exhibiting abnormal results in the GMs assessment, motor developmental delay according to the AIMS, or developmental delay based on Balley-III were promptly referred to early intervention services.

CONCLUSION

This study demonstrated high participation rate and low dropout in a developmental follow-up program employing a hybrid format. The substantial number of identified infants with developmental delay emphasizes the importance of timely detection of motor delays to referral to early intervention services.

General Movements trajectories and outcome at 12 months in very preterm infants: An analysis of tendencies and pathological persistence

Very preterm infants (VPI) < 32 weeks are at increased risk of developmental disorders detectable using the Prechtl General Movements Assessment (GMA) and the Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III). The aim of this study was to investigate General Movements (GMs) trajectories from preterm to fidgety age including GMs tendencies and their association with cognitive and motor outcome. Retrospective analysis of VPI with GMA at preterm (35 ± 2 weeks postmenstrual age (PMA), T1) and fidgety age (12 ± 3 weeks corrected age CA), T2), and BSID-III (12 ± 3 months CA, T3) is performed. Data are analysed using Pearson χ2-test, Fisher-Freeman-Halton Exact test, and residual analyses. This study found significant associations between (a) GMs (T1) and (b) persistent pathological GMs (T1 + T2) with cognitive outcomes at 12 months (T3) considering the tendencies of GMs in addition to the global character (p = 0.007, p = 0.022, respectively), representing medium-sized effects. There were no significant associations between GMs or persistence of pathological GMs and gross and fine motor outcomes, regardless of GMs tendencies. Findings indicate that considering tendencies of GMs and the persistence of pathological GMs may be important in identifying children at risk of cognitive impairments early. This additional assessment parameter may have the potential for early identification of infants with milder motor and/or cognitive impairments. However, more research is needed using larger sample cohorts to generalise the results and to be able to recommend sequential GMA for clinical routine.

Association between the General Movement Optimality Score and clinical features in newborns during hospitalization: A cross-sectional study

AIMS

To describe the General Movements (GMs) of hospitalized newborns to verify if their global and detailed GMA are related and if their GMs are associated with clinical features.

METHODS

Cross-sectional study. Thirty-eight preterm and full-term newborns, who were hospitalized in the neonatal intermediate care unit of a reference hospital, were included. Prechtl's General Movement Assessment (GMA), including the General Movement Optimality Score (GMOS) list, was used as an assessment tool. Clinical variables, such as preterm birth, birthweight, length of hospitalization, Apgar scores, pregnancy problems, admission at neonatal intensive care unit, use of invasive mechanical ventilation, and brain imaging findings were also collected. Newborns were videoed at a single time for 3 min before discharge.

RESULTS

Most newborns presented GMs with normal or poor repertoire quality. GMOS ranged from 17 to 42 points. Scores were lower in abnormal GMs. Abnormal GMs were associated with preterm birth, length of hospital stay >30 days and birthweight <2500 g. Accordingly, lower GMOSs were also associated with preterm birth, a birthweight <2500 g and a hospital stay >30 days but also with the invasive mechanical ventilation application.

CONCLUSION

Preterm and full-term newborns presented normal or abnormal GMs during hospitalization. Preterm birth, low birthweight, longer hospital stay and a time period of invasive ventilation were associated with worse GM behaviors.