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Doi H, Furui A, Ueda R, Shimatani K, Yamamoto M, Sakurai K, Mori C, Tsuji T. Spatiotemporal patterns of spontaneous movement in neonates are significantly linked to risk of autism spectrum disorders at 18 months old. Sci Rep 2023; 13:13869. [PMID: 37620366 PMCID: PMC10449803 DOI: 10.1038/s41598-023-40368-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Infants make spontaneous movements from the prenatal period. Several studies indicate that an atypical pattern of body motion during infancy could be utilized as an early biomarker of autism spectrum disorders (ASD). However, to date, little is known about whether the body motion pattern in neonates is associated with ASD risk. The present study sought to clarify this point by examining, in a longitudinal design, the link between features of spontaneous movement at about two days after birth and ASD risk evaluated using the Modified Checklist for Autism in Toddlers by their caregivers at 18 months old. The body movement features were quantified by a recently developed markerless system of infant body motion analysis. Logistic regression analysis revealed that ASD risk at 18 months old is associated with the pattern of spontaneous movement at the neonatal stage. Further, logistic regression based on body movement features during sleep shows better performance in classifying high- and low-risk infants than during the awake state. These findings raise the possibility that early signs of ASD risk may emerge at a developmental stage far earlier than previously thought.
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Affiliation(s)
- Hirokazu Doi
- Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan.
- School of Science and Engineering, Kokushikan University, 4-28-1 Setagaya, Setagaya-ku, Tokyo, 154-8515, Japan.
- Department of Information and Management Systems Engineering, Nagaoka University of Technology, 1603-1 Kamitomioka, Nagaoka, Niigata, 940-2188, Japan.
| | - Akira Furui
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-hiroshima, Hiroshima, 739-8527, Japan.
| | - Rena Ueda
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-hiroshima, Hiroshima, 739-8527, Japan
| | - Koji Shimatani
- Faculty of Health and Welfare, Prefectural University of Hiroshima, 1-1, Gakuen-machi, Mihara, Hiroshima, 734-8558, Japan
| | - Midori Yamamoto
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan
| | - Kenichi Sakurai
- Department of Nutrition and Metabolic Medicine, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan
| | - Chisato Mori
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Toshio Tsuji
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-hiroshima, Hiroshima, 739-8527, Japan.
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Örtqvist M, Bos AF, Ådén U, Einspieler C. "Fidgety-like movements" in extremely preterm infants - A new entity of spontaneous movements. Eur J Paediatr Neurol 2023; 45:7-8. [PMID: 37229970 DOI: 10.1016/j.ejpn.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/16/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Maria Örtqvist
- Department of Women's and Children's Health, Neonatal Research Unit, Karolinska Institutet, Eugeniavägen 27, H3:03, 171 64, Solna, Stockholm, Sweden; Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.
| | - Arend F Bos
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Ulrika Ådén
- Department of Women's and Children's Health, Neonatal Research Unit, Karolinska Institutet, Eugeniavägen 27, H3:03, 171 64, Solna, Stockholm, Sweden; Linköping University, Sweden; Crown Princess Victoria's Children's and Youth Hospital, University Hospital, Universitetssjukhuset, 581 85, Linköping, Sweden.
| | - Christa Einspieler
- IDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria.
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Yardımcı-Lokmanoğlu BN, Livanelioğlu A, Porsnok D, Sırtbaş-Işık G, Topal Y, Mutlu A. Early Spontaneous Movements and Sensory Processing in Preterm Infants. Am J Occup Ther 2023; 77:7703205070. [PMID: 37352432 DOI: 10.5014/ajot.2023.050096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
IMPORTANCE Preterm infants are at higher risk of motor development abnormalities and sensory processing difficulties. Few studies have examined both movement development and sensory processing in the early months of life, and the results are controversial. OBJECTIVE In this cross-sectional study, we investigated (1) differences in early spontaneous movements and sensory processing between preterm infants born at <32 wk gestation and those born at 32 to 36 wk gestation when they reached corrected (postterm) age 3 to 5 mo and (2) the relationship between early spontaneous movements and sensory processing. PARTICIPANTS We included 50 preterm infants born at <32 wk gestation and 61 preterm infants born at 32 to 36 wk gestation. OUTCOMES AND MEASURES We assessed early spontaneous movements, including fidgety movements, using the General Movements Assessment (GMA), which provides the Motor Optimality Score (MOS), and sensory processing using the Infant Sensory Profile-2. RESULTS The preterm infants born at <32 wk gestation had lower MOS results (p = .035) and more sensory processing difficulties (p = .006) than those born at 32 to 36 wk gestation. We found no significant relationship between early spontaneous movements and sensory processing (p > .05). CONCLUSIONS AND RELEVANCE Preterm infants born at <32 wk gestation are at increased risk for motor development abnormalities and sensory processing difficulties. What This Article Adds: Assessment of both motor development and sensory processing can play a crucial role in identifying infants who need early intervention.
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Affiliation(s)
- Bilge Nur Yardımcı-Lokmanoğlu
- Bilge Nur Yardımcı-Lokmanoğlu, PhD, PT, is Assistant Professor, Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey;
| | - Ayşe Livanelioğlu
- Ayşe Livanelioğlu, PhD, PT, is Professor, Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Doğan Porsnok
- Doğan Porsnok, MSc, PT, is Research Assistant, Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Gülsen Sırtbaş-Işık
- Gülsen Sırtbaş-Işık, MSc, PT, is Research Assistant, Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Yusuf Topal
- Yusuf Topal, MSc, PT, is Research Assistant, Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Akmer Mutlu
- Akmer Mutlu, PhD, PT, is Professor, Developmental and Early Physiotherapy Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Dibbits MHJ, Rodijk LH, den Heijer AE, Bos AF, Verkade HJ, de Kleine RH, Alizadeh BZ, Hulscher JBF, Bruggink JLM. Neurodevelopment in patients with biliary atresia up to toddler age: Outcomes and predictability. Early Hum Dev 2023; 180:105754. [PMID: 37030125 DOI: 10.1016/j.earlhumdev.2023.105754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/10/2023]
Abstract
AIM To assess neurodevelopment in young patients with biliary atresia (BA) and to determine the predictive value of General Movement Assessment (GMA) at infant age for neurodevelopmental impairments at toddler age. METHOD Infants diagnosed with BA were prospectively included in a longitudinal study. Neurodevelopmental status was previously assessed before Kasai porto-enterostomy (KPE) and one month after KPE using Prechtl's GMA, including motor optimality scores. At 2-3 years, neurodevelopment was assessed using the Bayley Scales of Infant Development, and compared to the Dutch norm population. The predictive value of GMA at infant age for motor skills and cognition at toddler age was determined. RESULTS Neurodevelopment was assessed in 41 BA patients. At toddler age (n = 38, age 29 ± 5 months, 70 % liver transplantation), 13 (39 %) patients scored below-average on motor skills, and 6 (17 %) patients on cognition. Abnormal GMA after KPE predicted both below-average motor skills and cognitive score at toddler age (sensitivity, 91 % and 80 %; specificity 83 % and 67 %; negative predictive value, 94 % and 94 %; and, positive predictive value, 77 % and 33 %, resp.). INTERPRETATION One-third of toddlers with BA show impaired motor skills. GMA post-KPE has a high predictive value to identify infants with BA at risk of neurodevelopmental impairments.
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Affiliation(s)
- Marloes H J Dibbits
- Section of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, the Netherlands
| | - Lyan H Rodijk
- Section of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, the Netherlands
| | - Anne E den Heijer
- Section of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, the Netherlands
| | - Arend F Bos
- Section of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, the Netherlands
| | - Henkjan J Verkade
- Section of Pediatric Gastroenterology/Hepatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, the Netherlands
| | - Ruben H de Kleine
- Section of Hepato-pancreatico-biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, the Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Jan B F Hulscher
- Section of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, the Netherlands
| | - Janneke L M Bruggink
- Section of Pediatric Surgery, Department of Surgery, University Medical Center Groningen, the Netherlands.
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Sermpon N, Gima H. Relationship between fidgety movement and frequency of movement toward midline: An observational study. Early Hum Dev 2023; 177-178:105718. [PMID: 36801663 DOI: 10.1016/j.earlhumdev.2023.105718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Infants show other movements and posture patterns during the fidgety movement period, including movement toward midline (MTM). Few studies have quantified MTM occurring during the fidgety movement period. AIMS This study aimed to examine the relationship between fidgety movements (FMs) and MTM frequency and occurrence rate per minute, from two video data sets (video attached to Prechtl video manual and accuracy data from Japan). STUDY DESIGN Observational study. SUBJECTS It encompassed 47 videos. Of these, 32 were deemed normal FMs. The study amalgamated FMs that were sporadic, abnormal, or absent into a category of aberrant (n = 15). OUTCOME MEASURES Infant video data were observed. MTM item occurrences were recorded and calculated for occurrence percentage and MTM rate of occurrence per minute. The differences between groups for the upper limbs, lower limbs, and total MTM were statistically analysed. RESULTS Twenty-three infant videos of normal FMs and seven infant videos of aberrant FMs showed MTM. Eight infant videos of aberrant FMs showed no MTM, and only four with absent FMs were included. There was a significant difference in the total MTM rate of occurrence per minute between normal FMs versus aberrant FMs (p = 0.008). CONCLUSIONS This study presented MTM frequency and rate of occurrence per minute in infants who showed FMs during the fidgety movement period. Those who showed absent FMs also demonstrated no MTM. Further study may need a larger sample size of absent FMs and information on later development.
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Affiliation(s)
- Nisasri Sermpon
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Japan; Faculty of Physical Therapy, Mahidol University, Thailand
| | - Hirotaka Gima
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Japan.
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The General Movements Motor Optimality Score in High-Risk Infants: A Systematic Scoping Review. Pediatr Phys Ther 2023; 35:2-26. [PMID: 36288244 DOI: 10.1097/pep.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this systematic scoping review was to explore the use of the motor optimality score in the fidgety movement period in clinical practice, and to investigate evidence for the motor optimality score in predicting neurodevelopmental outcomes. SUMMARY OF KEY POINTS Thirty-seven studies, with 3662 infants, were included. Studies were conceptualized and charted into 4 categories based on the motor optimality score: prediction, outcome measure, descriptive, or psychometric properties. The most represented populations were preterm or low-birth-weight infants (16 studies), infants with cerebral palsy or neurological concerns (5 studies), and healthy or term-born infants (4 studies). CONCLUSION The motor optimality score has the potential to add value to existing tools used to predict risk of adverse neurodevelopmental outcomes. Further research is needed regarding the reliability and validity of the motor optimality score to support increased use of this tool in clinical practice. What this adds to the evidence : The motor optimality score has potential to improve the prediction of adverse neurodevelopmental outcomes. Further research on validity and reliability of the motor optimality score is needed; however, a revised version, the motor optimality score-R (with accompanying manual) will likely contribute to more consistency in the reporting of the motor optimality score in future.
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Domagalska-Szopa M, Szopa A, Serrano-Gómez ME, Hagner-Derengowska M, Behrendt J. Identification of risk factors in pre-term infants with abnormal general movements. Front Neurol 2022; 13:850877. [PMID: 36452169 PMCID: PMC9701825 DOI: 10.3389/fneur.2022.850877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 09/21/2022] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the relationship between prenatal, perinatal, and postnatal risk factors for neurodevelopmental impairment (NDI) with the outcomes of General Movement (GM) Assessment (GMA) in pre-term infants at 3-5 months of age. We sought to identify the risk factors associated with the predictors of psychomotor development in pre-term newborns, such as normal fidgety movements (FMs), absent FMs, or abnormal FMs, assessed during the fidgety period of motor development. METHODS The SYNAGIS program (prophylactic of Respiratory Syncytial Virus Infection) was used to identify risk factors for the development of neuromotor deficits in 164 pre-term infants who were at high risk of developing these deficits. Based on the GMA, all participants were divided into three groups of infants who presented: (1) normal FMs; (2) absent FMs; and (3) abnormal FMs. RESULTS The results of the current study suggest that abnormal GMs not only indicate commonly known factors like birth asphyxia (BA), respiratory distress syndrome (RDS), periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH) grades 3-4, but also predict the development of motor impairments. In the present study, several specific risk factors including bronchopulmonary dysplasia (BPD), infertility treatments, maternal acute viral/bacterial infections during pregnancy, and elevated bilirubin levels were identified as attributes of an atypical fidgety movement pattern. CONCLUSIONS Additional clinical data, such as risk factors for NDI associated with early predictors of psychomotor development in pre-term newborns, i.e., absent or abnormal FMs, may be helpful in predicting neurological outcomes in pre-term infants with developmental concerns in the 1st month of life.
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Affiliation(s)
| | - Andrzej Szopa
- Department of Physiotherapy, Medical University of Silesia, Katowice, Poland
- Rehabilitation and Medical Center Neuromed SC, Katowice, Poland
| | - María Eugenia Serrano-Gómez
- Facultad de Enfermería y Rehabilitación, Universidad de La Sabana, Chía, Colombia
- Facultad de Psicología Ciencias de la Educación y del Deporte Blanquerna, Universidad Ramon Llull, Barcelona, Spain
| | | | - Jakub Behrendt
- Department of Neonatal Intensive Care, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Malak R, Fechner B, Stankowska M, Wiecheć K, Szczapa T, Kasperkowicz J, Matthews-Kozanecka M, Brzozowska TM, Komisarek O, Daroszewski P, Samborski W, Mojs E. The Importance of Monitoring Neurodevelopmental Outcomes for Preterm Infants: A Comparison of the AIMS, GMA, Pull to Sit Maneuver and ASQ-3. J Clin Med 2022; 11:6295. [PMID: 36362524 PMCID: PMC9657223 DOI: 10.3390/jcm11216295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/04/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Clinicians and parents should closely monitor the neurodevelopment of very preterm infants. The aim of our study was to compare whether neurodevelopmental assessments completed by parents and those done by specialists yielded similar outcomes. We wanted to check whether the assessments completed by specialists and parents were comparable in outcomes to emphasize the important roles of early assessment of a child and of the parents in their child's treatment and medical care. Another aim was to check whether or not the pull to sit maneuver from the Neonatal Behavioral Assessment Scale (NBAS) is still a parable item in well-known scales of neurodevelopment. METHODS We assessed 18 preterm neonates in the fourth month of corrected age with scales such as the General Movement Assessment (GMA), the Alberta Infant Motor Scale (AIMS), and the pull to sit maneuver from the NBAS. Finally, we asked parents to complete the Ages and Stages Questionnaire, Third Edition (ASQ-3). RESULTS We found that the respective assessments completed by specialists and parents are comparable in outcomes. We also found that the pull to sit item from the NBAS was still a valid test since it showed similar findings to those from the AIMS, the GMA, and the ASQ-3. CONCLUSIONS The pull to sit item from the NBAS is an important item for assessment of very preterm infants. Specialists should also take into consideration the input and concerns of parents when planning for treatment and intervention.
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Affiliation(s)
- Roksana Malak
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-545 Poznan, Poland
| | - Brittany Fechner
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-545 Poznan, Poland
| | - Marta Stankowska
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-545 Poznan, Poland
| | - Katarzyna Wiecheć
- Department of Clinical Psychology, Poznań University of Medical Sciences, 60-812 Poznan, Poland
| | - Tomasz Szczapa
- Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, II Department of Neonatology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
| | - Joanna Kasperkowicz
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-545 Poznan, Poland
| | - Maja Matthews-Kozanecka
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Teresa Matthews Brzozowska
- Department of Orthodontics and Masticatory Dysfunction, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Oskar Komisarek
- The Chair and Clinic of Maxillofacial Orthopaedics and Orthodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland
- Department of Plastic, Reconstructive and Aesthetic Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-821 Bydgoszcz, Poland
| | - Przemysław Daroszewski
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, 61-545 Poznan, Poland
| | - Włodzimierz Samborski
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-545 Poznan, Poland
| | - Ewa Mojs
- Department of Clinical Psychology, Poznań University of Medical Sciences, 60-812 Poznan, Poland
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John HB, Oommen SP, Swathi TO, Kumar M, Stoen R, Adde L. Preterm General Movements in Prediction of Neurodevelopmental Disability and Cerebral Palsy at Two Years: A Prospective Cohort Study. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kwong AKL, Doyle LW, Olsen JE, Eeles AL, Zannino D, Mainzer RM, Cheong JLY, Spittle AJ. Parent-recorded videos of infant spontaneous movement: Comparisons at 3-4 months and relationships with 2-year developmental outcomes in extremely preterm, extremely low birthweight and term-born infants. Paediatr Perinat Epidemiol 2022; 36:673-682. [PMID: 35172019 DOI: 10.1111/ppe.12867] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infants born extremely preterm (EP, <28-week gestational age) or extremely low birthweight (ELBW, <1000 g) are at risk of developmental delay and cerebral palsy (CP). The General Movements Assessment (GMA) and its extension, the Motor Optimality Score, revised (MOS-R) (assesses movement patterns and posture), may help to identify early delays. OBJECTIVES To compare differences in the MOS-R scored from parent-recorded videos between infants born EP/ELBW and term-born infants, to determine relationships between the MOS-R and 2-year cognitive, language and motor outcomes and if any relationships differ between birth groups and the association of the GMA (fidgety) with CP. METHODS A geographical cohort (EP/ELBW and term-control infants) was assessed using the MOS-R inclusive of the GMA at 3- to 4-month corrected age (CA), and the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) at 2-year CA. Differences in mean total MOS-R between groups, relationships between MOS-R and 2-year outcomes and relationships between GMA (fidgety) and CP in infants born EP/ELBW were estimated using linear/logistic regression. RESULTS Three hundred and twelve infants (147 EP/ELBW; 165 term) had complete MOS-R and Bayley-III assessments. Mean MOS-R was lower in infants born EP/ELBW than controls (mean difference -3.2, 95% confidence interval [CI] -4.2, -2.3). MOS-R was positively related to cognitive (β [regression coefficient] = 0.71, 95% CI 0.27, 1.15), language (β = 0.96, 95% CI 0.38, 1.54) and motor outcomes (β = .89, 95% CI 0.45, 1.34). There was little evidence for interaction effects between birth groups for any outcome. Absent/abnormal fidgety movements were related to CP in children born EP/ELBW (risk ratio 5.91, 95% CI 1.48, 23.7). CONCLUSIONS Infants born EP/ELBW have lower MOS-R than infants born at term. A higher MOS-R is related to better outcomes for 2-year development, with similar relationships in both birth groups. Absent/abnormal fidgety movements are related to CP in EP/ELBW survivors.
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Affiliation(s)
- Amanda K L Kwong
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Joy E Olsen
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Abbey L Eeles
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, Monash University, Parkville, Victoria, Australia
| | - Diana Zannino
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Rheanna M Mainzer
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
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Groos D, Adde L, Aubert S, Boswell L, de Regnier RA, Fjørtoft T, Gaebler-Spira D, Haukeland A, Loennecken M, Msall M, Möinichen UI, Pascal A, Peyton C, Ramampiaro H, Schreiber MD, Silberg IE, Songstad NT, Thomas N, Van den Broeck C, Øberg GK, Ihlen EA, Støen R. Development and Validation of a Deep Learning Method to Predict Cerebral Palsy From Spontaneous Movements in Infants at High Risk. JAMA Netw Open 2022; 5:e2221325. [PMID: 35816301 PMCID: PMC9274325 DOI: 10.1001/jamanetworkopen.2022.21325] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Early identification of cerebral palsy (CP) is important for early intervention, yet expert-based assessments do not permit widespread use, and conventional machine learning alternatives lack validity. OBJECTIVE To develop and assess the external validity of a novel deep learning-based method to predict CP based on videos of infants' spontaneous movements at 9 to 18 weeks' corrected age. DESIGN, SETTING, AND PARTICIPANTS This prognostic study of a deep learning-based method to predict CP at a corrected age of 12 to 89 months involved 557 infants with a high risk of perinatal brain injury who were enrolled in previous studies conducted at 13 hospitals in Belgium, India, Norway, and the US between September 10, 2001, and October 25, 2018. Analysis was performed between February 11, 2020, and September 23, 2021. Included infants had available video recorded during the fidgety movement period from 9 to 18 weeks' corrected age, available classifications of fidgety movements ascertained by the general movement assessment (GMA) tool, and available data on CP status at 12 months' corrected age or older. A total of 418 infants (75.0%) were randomly assigned to the model development (training and internal validation) sample, and 139 (25.0%) were randomly assigned to the external validation sample (1 test set). EXPOSURE Video recording of spontaneous movements. MAIN OUTCOMES AND MEASURES The primary outcome was prediction of CP. Deep learning-based prediction of CP was performed automatically from a single video. Secondary outcomes included prediction of associated functional level and CP subtype. Sensitivity, specificity, positive and negative predictive values, and accuracy were assessed. RESULTS Among 557 infants (310 [55.7%] male), the median (IQR) corrected age was 12 (11-13) weeks at assessment, and 84 infants (15.1%) were diagnosed with CP at a mean (SD) age of 3.4 (1.7) years. Data on race and ethnicity were not reported because previous studies (from which the infant samples were derived) used different study protocols with inconsistent collection of these data. On external validation, the deep learning-based CP prediction method had sensitivity of 71.4% (95% CI, 47.8%-88.7%), specificity of 94.1% (95% CI, 88.2%-97.6%), positive predictive value of 68.2% (95% CI, 45.1%-86.1%), and negative predictive value of 94.9% (95% CI, 89.2%-98.1%). In comparison, the GMA tool had sensitivity of 70.0% (95% CI, 45.7%-88.1%), specificity of 88.7% (95% CI, 81.5%-93.8%), positive predictive value of 51.9% (95% CI, 32.0%-71.3%), and negative predictive value of 94.4% (95% CI, 88.3%-97.9%). The deep learning method achieved higher accuracy than the conventional machine learning method (90.6% [95% CI, 84.5%-94.9%] vs 72.7% [95% CI, 64.5%-79.9%]; P < .001), but no significant improvement in accuracy was observed compared with the GMA tool (85.9%; 95% CI, 78.9%-91.3%; P = .11). The deep learning prediction model had higher sensitivity among infants with nonambulatory CP (100%; 95% CI, 63.1%-100%) vs ambulatory CP (58.3%; 95% CI, 27.7%-84.8%; P = .02) and spastic bilateral CP (92.3%; 95% CI, 64.0%-99.8%) vs spastic unilateral CP (42.9%; 95% CI, 9.9%-81.6%; P < .001). CONCLUSIONS AND RELEVANCE In this prognostic study, a deep learning-based method for predicting CP at 9 to 18 weeks' corrected age had predictive accuracy on external validation, which suggests possible avenues for using deep learning-based software to provide objective early detection of CP in clinical settings.
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Affiliation(s)
- Daniel Groos
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sindre Aubert
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lynn Boswell
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Raye-Ann de Regnier
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Toril Fjørtoft
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Deborah Gaebler-Spira
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Shirley Ryan AbilityLab, Chicago, Illinois
| | - Andreas Haukeland
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marianne Loennecken
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Michael Msall
- Section of Developmental and Behavioral Pediatrics, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
- Kennedy Research Center on Neurodevelopmental Disabilities, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
| | - Unn Inger Möinichen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Aurelie Pascal
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Colleen Peyton
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
| | - Heri Ramampiaro
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Michael D. Schreiber
- Department of Pediatrics, University of Chicago, Comer Children’s Hospital, Chicago, Illinois
| | | | - Nils Thomas Songstad
- Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Niranjan Thomas
- Department of Neonatology, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | | | - Gunn Kristin Øberg
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Espen A.F. Ihlen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ragnhild Støen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neonatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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12
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Gima H, Nakamura T. Association between General Movements Assessment and Later Motor Delay (excluding Cerebral Palsy) in Low-Birth-Weight Infants. Brain Sci 2022; 12:brainsci12060686. [PMID: 35741571 PMCID: PMC9221334 DOI: 10.3390/brainsci12060686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/11/2022] [Accepted: 05/21/2022] [Indexed: 02/04/2023] Open
Abstract
The general movements (GMs) assessment is useful for the prediction of cerebral palsy (CP) and other developmental disorders. Developmental coordination disorder (DCD) is highly prevalent in low-birth-weight (LBW) infants. We investigated the association between aberrant GMs during early infancy and later motor development in LBW infants. The study included infants who fulfilled the following criteria: GMs assessed at 9–20 weeks post-term age; developmental quotient (DQ) assessed at 3 years of age using the Kyoto Scale; intelligence quotient (IQ) assessed at 6 years of age. Participants with normal IQs at 6 years of age without a diagnosis of CP (14 males and 37 females, 23–36 weeks gestation with birth weights of 492–1498 g) were categorized into normal (n = 39) and aberrant (n = 12) groups based on GMs assessment; DQ was compared between the groups. We investigated the items in the DQ assessment and found that the infants in the aberrant group were more frequently unable to perform. Infants in the aberrant group showed a significantly lower DQ in the ‘postural-motor domain’, and were more frequently unable to ‘climb the stairs with alternating legs’ and ‘Jump from a 15–20 cm platform’. This study highlights that GMs aberrancy in early infancy is associated with a delayed gross motor development, even in children with a typical development. The GMs assessment may be useful for the prediction of DCD.
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Affiliation(s)
- Hirotaka Gima
- Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo 116-8551, Japan
- Correspondence: ; Tel.: +81-3-3819-7154
| | - Tomohiko Nakamura
- Department of Neonatology, Nagano Children’s Hospital, 3100, Toyoshina, Azumino City, Nagano 399-8288, Japan;
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13
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Örtqvist M, Einspieler C, Ådén U. Early prediction of neurodevelopmental outcomes at 12 years in children born extremely preterm. Pediatr Res 2022; 91:1522-1529. [PMID: 33972686 DOI: 10.1038/s41390-021-01564-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Extremely preterm (EPT) birth is a major risk factor for neurodevelopmental impairments. The aim was to evaluate the predictive value of Prechtl General Movement Assessment (GMA), including the Motor Optimality Score-Revised (MOS-R), at 3 months corrected age (CA) for adverse neurodevelopmental outcome at the age of 12 years. METHODS The GMA, including the MOS-R, was applied at 3 months CA and outcomes were assessed at 12 years by Touwen's neurological examination, the Movement Assessment Battery for Children-2, and chart reviews. RESULTS Fifty-three infants born EPT (33 boys, mean GA 25 weeks, mean body weight 805 ± 156 g) were included. Forty-two (79%) children participated in the follow-up (mean age 12.3 ± 0.4) and 62% of these had adverse outcomes. The MOS-R differed between groups (p = 0.007). The respective predictive values of GMA, aberrant FMs, and the MOS-R cut-off of 21 for adverse outcomes were positive predictive values (PPVs) of 1.00 and 0.77, negative predictive value of 0.47 and 0.63, sensitivity of 0.31 and 0.77, and specificity of 1.00 and 0.77. CONCLUSIONS Using the Prechtl GMA, including the MOS-R, at 3 months CA predicted an overall adverse neurodevelopment at 12 years, with a high PPV, specificity, and sensitivity in children born EPT. IMPACT The Prechtl GMA, including the MOS-R, can improve early identification of long-term adverse neurodevelopmental outcomes. This is the first study to investigate the predictive value of the MOS-R for neurodevelopmental outcome at mid-school age in children born EPT. Using the GMA, including the MOS-R, is suggested as one important part of the neurological assessment at 3 months CA in children born EPT. Aberrant FMs in combination with a MOS of <21 is an indicator of an increased risk of future adverse neurodevelopment in children born EPT.
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Affiliation(s)
- Maria Örtqvist
- Neonatal Research Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
| | - Christa Einspieler
- Research Unit Interdisciplinary Developmental Neuroscience, Dept. Phoniatrics, Medical University of Graz, Graz, Austria
| | - Ulrika Ådén
- Neonatal Research Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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14
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Lev-Enacab O, Sher-Censor E, Einspieler C, Jacobi OA, Daube-Fishman G, Beni-Shrem S. Spontaneous movements, motor milestones, and temperament of preterm-born infants: Associations with mother-infant attunement. INFANCY 2022; 27:412-432. [PMID: 34989463 DOI: 10.1111/infa.12451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/26/2021] [Accepted: 12/13/2021] [Indexed: 12/26/2022]
Abstract
Preterm-born infants and their mothers are at higher risk of showing less attuned interactions. We sought to identify characteristics of preterm-born infants associated with the attunement of mother-infant interactions at the corrected ages of 3-4 months, looking specifically at motor behaviors. We focused on infants' spontaneous movements, achievement of motor milestones, and temperament, which at this young age is often manifested via movement. Sixty preterm-born infants (Mdngestation age in weeks = 33, 57.38% male, corrected age Mdn = 14 weeks, interquartile range = 13-16) and their mothers participated. Independent observers rated mother-infant attunement, infants' spontaneous movements, and infants' achievement of motor milestones. Mothers reported infant temperament. We found infants' smooth and fluent movement character and continual fidgety movements were associated with better attunement in terms of higher maternal sensitivity and non-intrusiveness and higher infant responsiveness and involvement. Unexpectedly, infants' achievement of motor milestones was not significantly associated with mother-infant attunement, and maternal reports of infants' higher soothability were associated with lower maternal sensitivity. The study illustrates the value of including the assessment of infants' spontaneous movements, designed for early detection of neurological deficiencies, in research and in clinical practice with parents and preterm-born infants.
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Affiliation(s)
- Orna Lev-Enacab
- Maccabi Health Care Service, Haifa, Israel.,University of Haifa, Haifa, Israel
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15
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Abstract
PURPOSE This study aimed to investigate whether the movements and postures of 3- to 5-month-old infants with torticollis differ from those of infants without torticollis and to determine the relationship between clinical characteristics and the Motor Optimality Score (MOS) in torticollis. METHODS Participants were 40 infants with torticollis and 40 infants developing typically without torticollis. The infants were evaluated with detailed general movement assessment. RESULTS There were significant differences in the MOS and subcategory scores for age-adequate movement repertoire and observed postural patterns between groups. Clinical characteristics were not related to the reduction in the MOS. CONCLUSIONS Infants with torticollis have differences in movements and postures at 3 to 5 months of age compared with controls. Strategies supporting the movement repertoire of infants with torticollis can be added to rehabilitation programs for infants with the lower MOS to optimize their motor development.
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16
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van Dokkum NH, Bachini S, Verkaik-Schakel RN, Baptist DH, Salavati S, Kraft KE, Scherjon SA, Bos AF, Plösch T. Differential Placental DNA Methylation of NR3C1 in Extremely Preterm Infants With Poorer Neurological Functioning. Front Pediatr 2022; 10:876803. [PMID: 35722484 PMCID: PMC9198301 DOI: 10.3389/fped.2022.876803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Understanding underlying mechanisms of neurodevelopmental impairment following preterm birth may enhance opportunities for targeted interventions. We aimed to assess whether placental DNA methylation of selected genes affected early neurological functioning in preterm infants. METHODS We included 43 infants, with gestational age <30 weeks and/or birth weight <1,000 g and placental samples at birth. We selected genes based on their associations with several prenatal conditions that may be related to poor neurodevelopmental outcomes. We determined DNA methylation using pyrosequencing, and neurological functioning at 3 months post-term using Prechtl's General Movement Assessment, including the Motor Optimality Score-Revised (MOS-R). RESULTS Twenty-four infants had atypical MOS-R, 19 infants had near-optimal MOS-R. We identified differences in average methylation of NR3C1 (encoding for the glucocorticoid receptor) [3.3% (95%-CI: 2.4%-3.9%) for near-optimal vs. 2.3% (95%-CI: 1.7%-3.0%), p = 0.008 for atypical], and at three of the five individual CpG-sites. For EPO, SLC6A3, TLR4, VEGFA, LEP and HSD11B2 we found no differences between the groups. CONCLUSION Hypomethylation of NR3C1 in placental tissue is associated with poorer neurological functioning at 3 months post-term in extremely preterm infants. Alleviating stress during pregnancy and its impact on preterm infants and their neurodevelopmental outcomes should be further investigated.
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Affiliation(s)
- Nienke H van Dokkum
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sofia Bachini
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rikst Nynke Verkaik-Schakel
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Dyvonne H Baptist
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sahar Salavati
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Karianne E Kraft
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sicco A Scherjon
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Arend F Bos
- Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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17
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Khurana S, Rao BK, Lewis LE, Kumaran SD, Kamath A, Einspieler C, Dusing SC. Neonatal PT Improves Neurobehavior and General Movements in Moderate to Late Preterm Infants Born in India: An RCT. Pediatr Phys Ther 2021; 33:208-216. [PMID: 34618744 DOI: 10.1097/pep.0000000000000824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine whether a structured neonatal physical therapy program (SNP) improves neurobehavior and general movements in moderate to late preterm (MLP) infants. METHODS Sixty MLP infants participated in this clinical trial. After baseline assessment using the Neurobehavioral Assessment of Preterm Infant (NAPI) and Prechtl General Movements (GMs) Assessment, infants were randomly allocated to a usual care (n = 30) or an SNP group (n = 30) and continued receiving usual care. The SNP group received intervention for 90 minutes/day, 6 days/week until discharge. Changes in neurobehavior and GMs were assessed at hospital discharge. RESULTS Changes in scores on scarf sign and motor development and vigor clusters of NAPI document an improvement in the SNP group. The proportion of infants with poor repertoire GMs also decreased more in the SNP group than in the usual care group. CONCLUSION The SNP may be effective in improving some aspects of neurobehavior and quality of GMs in MLP infants. WHAT THIS ADDS TO THE EVIDENCE The addition of a structured neonatal physical therapy program to usual care can promote neurobehavioral organization and improve the quality of general movements in moderate and late preterm infants in India.
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Affiliation(s)
- Sonia Khurana
- Department of Physical Therapy (Dr Khurana), Motor Development Lab, Virginia Commonwealth University, Richmond, Virginia; Department of Physiotherapy (Drs Rao and Kumaran), Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Department of Paediatrics (Drs Lewis), Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India; Department of Data Science (Dr Kamath), Manipal Academy of Higher Education, Manipal, Karnataka, India; Division of Phoniatrics (Dr Einspieler), Medical University of Graz, Graz, Austria; Division of Biokinesiology and Physical Therapy (Dr Dusing), University of Southern California, Los Angeles, California
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18
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Hadas IM, Joseph M, Luba Z, Michal KL. Assessing parasympathetic measures of heart rate variability shortly after birth to predict motor repertoire at four months in low risk preterm infants born between 28 and 32 weeks of gestation. Early Hum Dev 2021; 161:105438. [PMID: 34392066 DOI: 10.1016/j.earlhumdev.2021.105438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
In low risk preterm infants, the risk for mild to moderate neuro-motor impairment is extremely high. Additionally, the autonomic nervous system (ANS) function was also found to be impaired. ANS activity may predict neuro-motor development at four months corrected age. This study examines the predictive value of the ANS function in detecting neuro-motor impairments during the first 4 months of life among low risk preterm infants born between 28 and 32 weeks of gestation. 46 infants were recruited. For each infant, heart rate variability (HRV) measures were obtained at week born, 32- and 35-weeks postmenstrual age (PMA). The General Movement Assessment (GMA) and the Motor Optimality Score for 3- to 5- Month- Old Infants (MOS) were performed at 35 weeks PMA and at 4 months corrected age respectively. A significant correlation was found between the parasympathetic nervous system (PSNS) components of HRV and the MOS evaluation. Preterm infants with suboptimal MOS scores showed significantly lower HRV values in the components of the PSNS (0.01 < p-value <0.04). A weak correlation was found between the HRV and the GMA. A Receiver Operating Characteristic was designed and revealed the predictive validity of the PSNS in preterm infants with a suboptimal MOS score. The current study shows that among very preterm infants with no additional risk factors, the PSNS component of HRV can predict neuro-motor outcome at 4 months corrected age and may be used as an early sign for mild neuro-motor impairments in order to initiate an early intervention program.
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Affiliation(s)
- Israeli-Mendlovic Hadas
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Mendlovic Joseph
- Shaare Zedek Medical Center, Jerusalem, Israel; Hadassah-Hebrew University School of Medicine, Jerusalem, Israel.
| | - Zuk Luba
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Katz-Leurer Michal
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
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19
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Yardımcı-Lokmanoğlu BN, Einspieler C, Sırtbaş G, Porsnok D, Arıkan Z, Livanelioğlu A, Mutlu A. The Effects of Different Exteroceptive Experiences on the Early Motor Repertoire in Infants With Down Syndrome. Phys Ther 2021; 101:6309593. [PMID: 34174075 DOI: 10.1093/ptj/pzab163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 03/07/2021] [Accepted: 05/12/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Down syndrome is a chromosomal abnormality in which muscle tone, motor development, and sensory systems are affected. The objectives of this study were to examine the changes in movements and postures of 3- to 5-month-old infants with Down syndrome and infants who were neurotypical controls during exposure to a rough-textured surface and to compare the differences occurring before and during an exteroceptive condition that was different between the 2 groups. METHODS In this quasi-experimental study, participants were 20 infants with Down syndrome (8 female infants; age range = 10-18 weeks, mean [SD] = 12 weeks 2 days [2 weeks 2 days]) and 20 age-matched infants with typical development (8 female infants; age range = 9-17 weeks, mean (SD) = 12 weeks 6 days [1 week 5 days]). The movements and postures of the infants, including fidgety movements, were assessed according to the General Movements Assessment, which determines the Motor Optimality Score (MOS), on 2 surfaces. RESULTS The MOS outcomes of the infants with Down syndrome (median = 21.5, range = 6-28) were significantly lower than those of the infants who were neurotypical (median = 28, range = 23-28) on a standard mattress. The postures were found to be significantly better in infants with Down syndrome during exposure to a rough-textured surface. The MOS did not change due to the different exteroceptive experiences in infants with Down syndrome and infants who were neurotypical. CONCLUSION The different exteroceptive experiences caused only postural alterations, which might play a crucial role in early intervention programs for infants with Down syndrome. IMPACT This is the first study, to our knowledge, on the effects of different exteroceptive conditions, such as a coco coir mattress covered with muslin fabric, on the early motor repertoire in infants with Down syndrome. The findings showed that infants with Down syndrome had heterogeneity in their fidgety movements and large variability of the MOS, and the MOS results from infants with Down syndrome were lower than those of infants who were neurotypical. Fidgety movements and the MOS did not change due to the different exteroceptive experiences in either group. Significant improvements in posture were observed during exposure to a rough-textured surface. The improvement of posture is essential; clinicians might consider the positive effect of putting an infant with Down syndrome on a rough-textured surface and include this strategy in early intervention programs.
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Affiliation(s)
- Bilge Nur Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Christa Einspieler
- Medical University of Graz, Division of Phoniatrics, Research Unit Interdisciplinary Developmental Neuroscience (iDN), Graz, Austria
| | - Gülsen Sırtbaş
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Doğan Porsnok
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Zeynep Arıkan
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Ayşe Livanelioğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
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20
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Salavati S, Bos AF, Doyle LW, Anderson PJ, Spittle AJ. Very Preterm Early Motor Repertoire and Neurodevelopmental Outcomes at 8 Years. Pediatrics 2021; 148:peds.2020-049572. [PMID: 34452979 DOI: 10.1542/peds.2020-049572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children born very preterm (<32 weeks' gestation) have more neurodevelopmental problems compared with term-born peers. Aberrant fidgety movements (FMs) are associated with adverse motor outcomes in children born very preterm. However, associations of aberrant FMs combined with additional movements and postures to give a motor optimality score-revised (MOS-R) with school-aged cognitive and motor outcomes are unclear. Our aim with this study was to determine those associations. METHODS Of 118 infants born <30 weeks' gestation recruited into a randomized controlled trial of early intervention, 97 had a general movements assessment at 3 months' corrected age and were eligible for this study. Early motor repertoire including FMs and MOS-R were scored from videos of infant's spontaneous movement at 3 months' corrected age. At 8 years' corrected age, cognitive and motor performances were evaluated. Associations of early FMs and MOS-R with outcomes at 8 years were determined using linear regression. RESULTS Seventy-eight (80%) infants with early motor repertoire data had neurodevelopmental assessments at 8 years. A higher MOS-R, and favorable components of the individual subscales of the MOS-R, including the presence of normal FMs, were associated with better performance for general cognition, attention, working memory, executive function and motor function at 8 years; eg, presence of normal FMs was associated with a 21.6 points higher general conceptual ability score (95% confidence interval: 12.8-30.5; P < .001) compared with absent FMs. CONCLUSIONS Favorable early motor repertoire of infants born <30 weeks is strongly associated with improved cognitive and motor performance at 8 years.
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Affiliation(s)
- Sahar Salavati
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Obstetrics and Gynaecology.,Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Departments of Physiotherapy.,Newborn Research, Royal Women's Hospital, Melbourne, Australia
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Çelik G, Fırat T. How brachial plexus birth palsy affects motor development and upper extremity skill quality? Childs Nerv Syst 2021; 37:2865-2871. [PMID: 34196747 DOI: 10.1007/s00381-021-05249-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to investigate the gross motor functions including head control, midline crossing, and rolling, and the relationship between these developmental skills and upper extremity skill quality in children with neonatal brachial plexus palsy (NBPP). METHODS A total of 106 children with NBPP, aged 10-18 months, were included in this study. Injury severity was determined with the Narakas Classification. The gross motor function measurement lying and rolling sub-scale was used to evaluate gross motor functions including head control, midline crossing, and rolling, while the Quality of Upper Extremity Skills Test was applied to assess the upper extremity skill quality. The assessments were performed only once during routine physiotherapy controls. RESULTS As the severity of injury increased, developmental skill capacity decreased and upper extremity skill quality deteriorated (ps = 0.0001). There was a strong positive correlation between these developmental skills and upper extremity skill quality (ps = 0.0001). CONCLUSION Developmental skills are affected by NBPP. Rehabilitation programs aimed at increasing the quality of upper extremity skills should be included in neurodevelopmental treatment approaches.
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Affiliation(s)
- Gülay Çelik
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Tüzün Fırat
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
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Aizawa CYP, Einspieler C, Genovesi FF, Ibidi SM, Hasue RH. The general movement checklist: A guide to the assessment of general movements during preterm and term age. J Pediatr (Rio J) 2021; 97:445-452. [PMID: 33147443 PMCID: PMC9432338 DOI: 10.1016/j.jped.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022] Open
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.
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Affiliation(s)
- Carolina Yuri Panvequio Aizawa
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil.
| | | | - Fernanda Françoso Genovesi
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Silvia Maria Ibidi
- Universidade de São Paulo (USP), Hospital Universitário, Unidade de Neonatologia, Divisão de Clínica Pediátrica, São Paulo, SP, Brazil
| | - Renata Hydee Hasue
- Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
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The ontogeny of limbs movements towards midline in healthy infants born at term. Early Hum Dev 2021; 155:105324. [PMID: 33581484 DOI: 10.1016/j.earlhumdev.2021.105324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/04/2021] [Accepted: 01/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Movements towards midline are part of the age-adequate motor repertoire of infants. They develop contemporaneously to general movements, changing from occasional simple contact to proper midline motor patterns. AIM The aim of this study is to describe the ontogeny of movements towards midline in full term healthy infants. STUDY DESIGN Parents were asked to record their infant every second week, from term age to 22 weeks post-term. SUBJECTS 25 healthy full-term infants. RESULTS Three main epochs of development were detected: in the first one, between birth and 4 weeks post-term, movements towards midline were occasional, apparently due to the dominant flexed posture of elbow and knees and the adducted posture of shoulders and hips. In the second epoch, from 4 to 8 weeks, the limbs movements towards midline markedly decreased. In the third one, after 8 weeks, movements towards midline increased again in frequency, first appearing in lower limbs then in upper limbs, first solely as contact and thereafter as manipulation. A temporal overlapping with the occurrence of intermittent or continual fidgety movements was detected. CONCLUSIONS Movements towards midline progressively change, through a defined timeline, in full term healthy infants. The increased knowledge about the normal age-adequate motor repertoire can help physicians in clinical assessment of high risk infants.
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Early Motor Repertoire in Infants With Biliary Atresia: A Nationwide Prospective Cohort Study. J Pediatr Gastroenterol Nutr 2021; 72:592-596. [PMID: 33346571 DOI: 10.1097/mpg.0000000000003021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the study was to assess the neurological status in infants with biliary atresia (BA) at time of diagnosis, using Prechtl's validated General Movement Assessment. METHODS Infants diagnosed with BA were prospectively included in a nationwide cohort study. From birth to approximately 46 weeks of postmenstrual age (PMA), general movements (GMs) are defined as "writhing movements." At 46 to 49 weeks PMA, "'fidgety movements" emerge. The infant's early motor repertoire was recorded on video before Kasai portoenterostomy. We scored GM optimality scores (min-max 5-42) or motor optimality scores (MOS, min-max 5-28) as appropriate. We defined GM optimality scores <36 and MOS <26 as atypical, and compared the results with 2 reference groups of healthy peers. RESULTS We assessed GMs in 35 infants with BA (11/35 boys, gestational age 40 weeks [36-42], birth weight 3370 g [2015-4285]). At time of diagnosis (PMA 47 weeks [42-60]), 16 infants (46%) showed atypical GMs. The proportion of infants with atypical GMs was significantly higher in BA (46%) than in 2 reference groups of healthy infants (vs 10%, P < 0.001; vs 18%, P < 0.001). Total and direct bilirubin levels were 165 μmol/L (87-364) and 134 μmol/L (72-334), respectively, height z score was 0.05 (-2.90, 1.75), weight z score -0.52 ([-2.50, -0.20) and mean upper arm circumference z score -1.80 (-2.50, -0.20). We found no statistically significant relation between atypical GMs and clinical variables. CONCLUSIONS Almost half of the infants with BA showed atypical GMs at time of diagnosis, suggesting neurological impairment. Close monitoring of these infants is warranted to determine their individual neurodevelopmental trajectories.
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Movements and posture in infants born extremely preterm in comparison to term-born controls. Early Hum Dev 2021; 154:105304. [PMID: 33556691 DOI: 10.1016/j.earlhumdev.2020.105304] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Identifying altered motor development at an early stage is crucial for infants born extremely preterm (EPT), as they face a high risk of long-term neurodevelopmental impairment. The Prechtl General Movement Assessment (GMA), including the Motor Optimality Score Revised (MOS-R), can provide important insights into these infants' later neurodevelopmental function. AIMS To compare age-specific movements and postures in infants born EPT compared to term-born controls at three months corrected age. STUDY DESIGN A retrospective observational study design. SUBJECTS 53 infants born EPT (mean gestational age 25 weeks; 23-26) were included and matched for gender and recording age with 53 term-born controls (mean gestational age 40 weeks, 37-41). OUTCOME MEASURES GMA including the MOS-R at three months corrected age (re-analysis of video-recordings). RESULTS Of the infants born EPT, 19% showed aberrant fidgety movements (FMs); all term-born infants had normal FMs. There was a significant difference in MOS-R (p≤0.001) between controls (median = 26, IQR 26-28) and EPT infants (median = 18, IQR 17-21), as well as in all subcategories of the MOS-R. The EPT group had a significantly higher number of infants showing atypical movement and postural patterns as well as a reduced repertoire for the age compared to the controls. All infants born EPT moved monotonously and jerky. P-values were all <0.001. CONCLUSION Infants born EPT have an altered early motor development. The MOS-R may contribute to further understanding of motor performance in this group of children since it can detect neurological- and motor alterations at a very early age.
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Lucaccioni L, Boncompagni A, Pugliese M, Talucci G, Della Casa E, Bertoncelli N, Coscia A, Bedetti L, Berardi A, Iughetti L, Ferrari F. Subtle impairment of neurodevelopment in infants with late fetal growth restriction. J Matern Fetal Neonatal Med 2021; 35:4927-4934. [PMID: 33455501 DOI: 10.1080/14767058.2021.1873267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Children with late fetal growth restriction (FGR) are at high risk of being born small for gestational age (SGA). These categories of newborns are at increased risk for neurodevelopment impairment. The general movements assessment, in particular at fidgety age, has been used to predict neurological dysfunctions. This study aimed to evaluate growth recovery, presence of fidgety movements at 3 months, and neurodevelopmental outcome at 2 years of age in term late FGR infants and adequate for gestational age (AGA) controls. METHODS Prospective clinical evaluation. At 3 months auxological parameters (AP) and neurological examination were evaluated while at 24 months neurodevelopment outcome by Griffiths Mental Development Scales (GMDS-R) was evaluated. RESULTS 38 late FGR and 20 AGA controls completed the study. Despite a significant catch up, at 3 months 13% of late FGR presented at least one auxological parameter <3° percentile. Moreover, 23.7% of late FGR infants did not show fidgety movements compared to 100% AGA controls (p < .001). Cranial circumference at birth resulted a positive predictive factor for FMs (p = .039). At 2 years of age, a difference statistically significant between late FGR and AGA was detected in GMDS-R. CONCLUSION Independently from growth recovery, fidgety movements resulted less expressed in late FGR infants, and at 2 years of age the neurodevelopmental assessment revealed differences in each domain of evaluation between late FGR and AGA infants, although within normal ranges.
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Affiliation(s)
- Laura Lucaccioni
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Boncompagni
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Marisa Pugliese
- Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanna Talucci
- Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Della Casa
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Natascia Bertoncelli
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Luca Bedetti
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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De Roubaix A, Van de Velde D, Roeyers H, Van Waelvelde H. Standardized motor assessments before the age of five predicting school-aged motor outcome including DCD: A systematic review. Eur J Paediatr Neurol 2021; 30:29-57. [PMID: 33385976 DOI: 10.1016/j.ejpn.2020.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/10/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
AIM Developmental Coordination Disorder (DCD) is a common neurodevelopmental disorder usually diagnosed at primary-school-age. This systematic review aimed to summarize available standardized motor assessments before five years of age predicting DCD, complex Minor Neurological Disorder (cMND) and motor delay assessed by a standardized motor test. METHODS A systematic search was performed in MEDLINE, CINAHL, WoS, Scopus, CENTRAL and ERIC. A hand search was executed. Only data of non-Cerebral Palsy children was included. RESULTS At or before two years, the BSID, motor subtests of GMDS, NOMAS, and NSMDA might be valuable in detecting school-aged motor delay, while starting at three years, the PDMS, motor subtests of GMDS, NSDMA, M-ABC-2, and CAMPB show promising results. General movements Assessment is associated with cMND, but does not seem sensitive enough to detect DCD. Predictive values are superior in high-risk groups and improve as children age. However, no assessment instrument reached 80% sensitivity and specificity. CONCLUSION Standardized motor assessments before five years seem valuable in detecting early motor problems. More longitudinal research commencing in infancy, including multiple assessments over time and the implementation of clear diagnostic criteria is imperative.
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Affiliation(s)
- Amy De Roubaix
- Faculty of Medicine and Health Care Sciences, Department of Rehabilitation Sciences, Ghent University, Entrance 46, UZ Ghent, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Dominique Van de Velde
- Faculty of Medicine and Health Care Sciences, Department of Rehabilitation Sciences, Ghent University, Entrance 46, UZ Ghent, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Herbert Roeyers
- Faculty of Psychology and Educational Sciences, Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Hilde Van Waelvelde
- Faculty of Medicine and Health Care Sciences, Department of Rehabilitation Sciences, Ghent University, Entrance 46, UZ Ghent, C. Heymanslaan 10, 9000, Ghent, Belgium.
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General Movement Assessment Predicts Neuro-Developmental Outcome in Very Low Birth Weight Infants at Two Years - A Five-Year Observational Study. Indian J Pediatr 2021; 88:28-33. [PMID: 32488806 DOI: 10.1007/s12098-020-03365-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the value of general movements (GMs) in predicting the neurodevelopmental outcome using Bayley Scale of Infant Development III (BSID-III) at two years of age in very low birth weight (VLBW) infants. METHODS This is a five-year observational study (January 2012-June 2017). Two hundred twenty-seven VLBW infants were assessed in the neurodevelopmental clinic between Jan 2012 and June 2017. Of these 137 infants had GMs assessments at 3 mo post term (first visit to the clinic). RESULTS Absence of fidgety movements (FMs) at 3 mo post term had high specificity and negative predictive value for moderate to severe neurodevelopmental outcome in motor, cognition and language domains (composite score less than 70 in the Bayley III scales of Infant development scores). At 3 mo post term, absent FMs had high sensitivity, specificity and negative predictive value (NPV) for cerebral palsy (CP). CONCLUSIONS GMs assessment at 3 mo post term could be considered as an important screening tool for early identification of VLBW infants who are at risk of neurodevelopmental impairment/cerebral palsy.
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Goel D, Luig M, Maheshwari R, D'Cruz D, Goyen TA. General Movement assessment and neurodevelopmental trajectory in extremely preterm infants with hypothyroxinaemia of prematurity (THOP). Early Hum Dev 2020; 144:104886. [PMID: 31668678 DOI: 10.1016/j.earlhumdev.2019.104886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transient hypothyroxinaemia of prematurity (THOP) has been associated with neurodevelopmental deficits with a paucity of literature leading to variable practice. AIM Evaluation of the relationship between free T4 (fT4) levels at 2 weeks after birth and early markers of neurodevelopmental outcome. STUDY DESIGN A retrospective study of prospectively collected data from infants born <29 weeks' gestation, admitted to NICU between January 2012 and December 2014. The primary outcomes were the relationship between fT4 levels at 2 weeks, Prechtl General Movement Assessment (GMA) at 36 weeks and 3 months postterm age, and Bayley Scales of Infant Development (BSID-III) at 2 years postterm age. Secondary outcomes were survival free of disability and other neonatal morbidities. RESULTS Of 122 infants, 101 infants had normal fT4 levels (No-THOP) and 21 had fT4 levels >1SD below the mean (THOP group). There was increased frequency of abnormal GMA in the No-THOP group compared with the THOP group at 36 weeks (abnormal writhing GMs: 43% vs 21%, p = 0.15) and 3 months corrected age (absent fidgety GMs: 7.6% vs 0%, p = 0.36), though not statistically significant. The neurodevelopmental outcome was worse in the No-THOP group compared with the THOP group with significantly lower mean cognitive and motor scores at 2 year of corrected age (90 ± 13.8 vs 100 ± 8.3, p = 0.01 and 91 ± 15.2 vs 100 ± 13.2, p = 0.04 respectively). CONCLUSIONS This is the first report describing General Movements (GMs) in preterm infants with THOP. We found worse neurodevelopmental outcome in No-THOP infants reflected by significantly worse cognitive and motor outcomes at 2 years corrected age.
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Affiliation(s)
- Dimple Goel
- Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
| | | | - Rajesh Maheshwari
- Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - Daphne D'Cruz
- Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
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Abstract
PURPOSE The aim of this study was to define the movement characteristics and postures of infants with obstetric brachial plexus lesion. METHODS The study group included 20 infants with obstetric brachial plexus lesion and a control group of 20 infants with normal neurological outcome, aged 9 to 17 weeks postterm. Infants were evaluated by global and detailed general movements assessment. RESULTS There were no significant differences between the motor optimality scores of the 2 groups. However, there were some differences in terms of concurrent movements and the posture. Infants with obstetric brachial plexus lesion demonstrated more excitement bursts, head rotation, hand-knee contact, rolling, and few finger posture and postural asymmetry, and performed jerky movements when compared with the control group. CONCLUSIONS Obstetric brachial plexus lesion did not affect the quality of fidgety movements of the infants but leads to compensatory movements in concurrent movements on the unaffected sides.
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Mebius MJ, Bilardo CM, Kneyber MCJ, Modestini M, Ebels T, Berger RMF, Bos AF, Kooi EMW. Onset of brain injury in infants with prenatally diagnosed congenital heart disease. PLoS One 2020; 15:e0230414. [PMID: 32210445 PMCID: PMC7094875 DOI: 10.1371/journal.pone.0230414] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The exact onset of brain injury in infants with congenital heart disease (CHD) is unknown. Our aim was, therefore, to assess the association between prenatal Doppler flow patterns, postnatal cerebral oxygenation and short-term neurological outcome. METHODS Prenatally, we measured pulsatility indices of the middle cerebral (MCA-PI) and umbilical artery (UA-PI) and calculated cerebroplacental ratio (CPR). After birth, cerebral oxygen saturation (rcSO2) and fractional tissue oxygen extraction (FTOE) were assessed during the first 3 days after birth, and during and for 24 hours after every surgical procedure within the first 3 months after birth. Neurological outcome was determined preoperatively and at 3 months of age by assessing general movements and calculating the Motor Optimality Score (MOS). RESULTS Thirty-six infants were included. MOS at 3 months was associated with MCA-PI (rho 0.41, P = 0.04), UA-PI (rho -0.39, P = 0.047, and CPR (rho 0.50, P = 0.01). Infants with abnormal MOS had lower MCA-PI (P = 0.02) and CPR (P = 0.01) and higher UA-PI at the last measurement (P = 0.03) before birth. In infants with abnormal MOS, rcSO2 tended to be lower during the first 3 days after birth, and FTOE was significantly higher on the second day after birth (P = 0.04). Intraoperative and postoperative rcSO2 and FTOE were not associated with short-term neurological outcome. CONCLUSION In infants with prenatally diagnosed CHD, the prenatal period may play an important role in developmental outcome. Additional research is needed to clarify the relationship between preoperative, intra-operative and postoperative cerebral oxygenation and developmental outcome in infants with prenatally diagnosed CHD.
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Affiliation(s)
- Mirthe J. Mebius
- Division of Neonatology, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Catherina M. Bilardo
- Department of Obstetrics & Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin C. J. Kneyber
- Division of Pediatric Critical Care Medicine, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Critical Care, Anesthesiology, Peri-operative & Emergency medicine (CAPE), University of Groningen, Groningen, The Netherlands
| | - Marco Modestini
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tjark Ebels
- Center for Congenital Heart Diseases, Department of Cardiothoracic Surgery, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Rolf M. F. Berger
- Center for Congenital Heart Diseases, Pediatric Cardiology, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F. Bos
- Division of Neonatology, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth M. W. Kooi
- Division of Neonatology, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Peyton C, Einspieler C, Fjørtoft T, Adde L, Schreiber MD, Drobyshevsky A, Marks JD. Correlates of Normal and Abnormal General Movements in Infancy and Long-Term Neurodevelopment of Preterm Infants: Insights from Functional Connectivity Studies at Term Equivalence. J Clin Med 2020; 9:E834. [PMID: 32204407 PMCID: PMC7141532 DOI: 10.3390/jcm9030834] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 12/19/2022] Open
Abstract
Preterm infants born before 32 weeks gestation have increased risks for neurodevelopmental impairment at two years of age. How brain function differs between preterm infants with normal or impaired development is unknown. However, abnormal spontaneous motor behavior at 12-15 weeks post-term age is associated with neurodevelopmental impairment. We imaged brain blood oxygen level-dependent signals at term-equivalent age in 62 infants born at <32 weeks gestation and explored whether resting state functional connectivity (rsFC) differed with performances on the General Movement Assessment (GMA) at 12-15 weeks, and Bayley III scores at two years of corrected age. Infants with aberrant general movements exhibited decreased rsFC between the basal ganglia and regions in parietal and frontotemporal lobes. Infants with normal Bayley III cognitive scores exhibited increased rsFC between the basal ganglia and association cortices in parietal and occipital lobes compared with cognitively impaired children. Infants with normal motor scores exhibited increased rsFC between the basal ganglia and visual cortices, compared with children with motor impairment. Thus, the presence of abnormal general movements is associated with region-specific differences in rsFC at term. The association of abnormal long-term neurodevelopmental outcomes with decreased rsFC between basal ganglia and sub-score specific cortical regions may provide biomarkers of neurodevelopmental trajectory and outcome.
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Affiliation(s)
- Colleen Peyton
- Department of Pediatrics, University of Chicago, Chicago, IL 60422, USA
- Department of Physical Therapy and Human Movement Science and the Department of Pediatrics, Northwestern University, Chicago, IL 60611, USA
| | - Christa Einspieler
- Research Unit IDN, Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz 8036, Austria;
| | - Toril Fjørtoft
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.F.); (L.A.)
- Clinics of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Lars Adde
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway; (T.F.); (L.A.)
- Clinics of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | | | | | - Jeremy D. Marks
- Department of Pediatrics, University of Chicago, Chicago, IL 60422, USA
- Department of Neurology, University of Chicago, Chicago, IL 60422, USA
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The Predictive Accuracy of the General Movement Assessment for Cerebral Palsy: A Prospective, Observational Study of High-Risk Infants in a Clinical Follow-Up Setting. J Clin Med 2019; 8:jcm8111790. [PMID: 31717717 PMCID: PMC6912231 DOI: 10.3390/jcm8111790] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early prediction of cerebral palsy (CP) using the General Movement Assessment (GMA) during the fidgety movements (FM) period has been recommended as standard of care in high-risk infants. The aim of this study was to determine the accuracy of GMA, alone or in combination with neonatal imaging, in predicting cerebral palsy (CP). METHODS Infants with increased risk of perinatal brain injury were prospectively enrolled from 2009-2014 in this multi-center, observational study. FM were classified by two certified GMA observers blinded to the clinical history. Abnormal GMA was defined as absent or sporadic FM. CP-status was determined by clinicians unaware of GMA results. RESULTS Of 450 infants enrolled, 405 had scorable video and follow-up data until at least 18-24 months. CP was confirmed in 42 (10.4%) children at mean age 3 years 1 month. Sensitivity, specificity, positive and negative predictive values, and accuracy of absent/sporadic FM for CP were 76.2, 82.4, 33.3, 96.8, and 81.7%, respectively. Only three (8.1%) of 37 infants with sporadic FM developed CP. The highest accuracy (95.3%) was achieved by a combination of absent FM and abnormal neonatal imaging. CONCLUSION In infants with a broad range of neonatal risk factors, accuracy of early CP prediction was lower for GMA than previously reported but increased when combined with neonatal imaging. Sporadic FM did not predict CP in this study.
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Marchi V, Hakala A, Knight A, D'Acunto F, Scattoni ML, Guzzetta A, Vanhatalo S. Automated pose estimation captures key aspects of General Movements at eight to 17 weeks from conventional videos. Acta Paediatr 2019; 108:1817-1824. [PMID: 30883894 DOI: 10.1111/apa.14781] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 11/27/2022]
Abstract
AIM General movement assessment requires substantial expertise for accurate visual interpretation. Our aim was to evaluate an automated pose estimation method, using conventional video records, to see if it could capture infant movements using objective biomarkers. METHODS We selected archived videos from 21 infants aged eight to 17 weeks who had taken part in studies at the IRCCS Fondazione Stella Maris (Italy), from 2011 to 2017. Of these, 14 presented with typical low-risk movements, while seven presented with atypical movements and were later diagnosed with cerebral palsy. Skeleton videos were produced using a computational pose estimation model adapted for infants and these were blindly assessed to see whether they contained the information needed for classification by human experts. Movements of skeletal key points were analysed using kinematic metrics to provide a biomarker to distinguish between groups. RESULTS The visual assessments of the skeleton videos were very accurate, with Cohen's K of 0.90 when compared with the classification of conventional videos. Quantitative analysis showed that arm movements were more variable in infants with typical movements. CONCLUSION It was possible to extract automated estimation of movement patterns from conventional video records and convert them to skeleton footage. This could allow quantitative analysis of existing footage.
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Affiliation(s)
- Viviana Marchi
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
- Department of Developmental Neuroscience IRCCS Fondazione Stella Maris Pisa Italy
| | - Anna Hakala
- Neuro Event Labs Oy (2712284‐1) Tampere Finland
| | | | - Federica D'Acunto
- Department of Developmental Neuroscience IRCCS Fondazione Stella Maris Pisa Italy
| | - Maria Luisa Scattoni
- Research Coordination and Support Service Istituto Superiore di Sanità Rome Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience IRCCS Fondazione Stella Maris Pisa Italy
- Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology Children′s Hospital University of Helsinki and Helsinki University Hospital (HUH) Helsinki Finland
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Lee Mongerson CR, Jennings RW, Zurakowski D, Bajic D. Quantitative MRI study of infant regional brain size following surgery for long-gap esophageal atresia requiring prolonged critical care. Int J Dev Neurosci 2019; 79:11-20. [PMID: 31563705 DOI: 10.1016/j.ijdevneu.2019.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/05/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Little is known regarding the impact of concurrent critical illness and thoracic noncardiac perioperative critical care on postnatal brain development. Previously, we reported smaller total brain volumes in both critically ill full-term and premature patients following complex perioperative critical care for long-gap esophageal atresia (LGEA). Our current report assessed trends in regional brain sizes during infancy, and probed for any group differences. METHODS Full-term (n = 13) and preterm (n = 13) patients without any previously known neurological concerns, and control infants (n = 16), underwent non-sedated 3 T MRI in infancy (<1 year old). T2-weighted images underwent semi-automated brain segmentation using Morphologically Adaptive Neonatal Tissue Segmentation (MANTiS). Regional tissue volumes of the forebrain, deep gray matter (DGM), cerebellum, and brainstem are presented as absolute (cm3) and normalized (% total brain volume (%TBV)) values. Group differences were assessed using a general linear model univariate analysis with corrected age at scan as a covariate. RESULTS Absolute volumes of regions analyzed increased with advancing age, paralleling total brain size, but were significantly smaller in both full-term and premature patients compared to controls. Normalized volumes (%TBV) of forebrain, DGM, and cerebellum were not different between subject groups analyzed. Normalized brainstem volumes showed group differences that warrant future studies to confirm the same finding. DISCUSSION Both full-term and premature critically ill infants undergoing life-saving surgery for LGEA are at risk of smaller total and regional brain sizes. Normalized volumes support globally delayed or diminished brain growth in patients. Future research should look into neurodevelopmental outcomes of infants born with LGEA.
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Affiliation(s)
- Chandler Rebecca Lee Mongerson
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Bader 3, 300 Longwood Ave., Boston, MA, United States
| | - Russell William Jennings
- Esophageal and Airway Treatment Center, Department of Surgery, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
- Harvard Medical School, 25 Shattuck St., Boston, MA, United States
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Bader 3, 300 Longwood Ave., Boston, MA, United States
- Esophageal and Airway Treatment Center, Department of Surgery, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
- Harvard Medical School, 25 Shattuck St., Boston, MA, United States
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Bader 3, 300 Longwood Ave., Boston, MA, United States
- Esophageal and Airway Treatment Center, Department of Surgery, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
- Harvard Medical School, 25 Shattuck St., Boston, MA, United States
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Ferrari F, Plessi C, Lucaccioni L, Bertoncelli N, Bedetti L, Ori L, Berardi A, Della Casa E, Iughetti L, D'Amico R. Motor and Postural Patterns Concomitant with General Movements Are Associated with Cerebral Palsy at Term and Fidgety Age in Preterm Infants. J Clin Med 2019; 8:jcm8081189. [PMID: 31398881 PMCID: PMC6723626 DOI: 10.3390/jcm8081189] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022] Open
Abstract
General movements (GMs) in combination with neurological examination and magnetic resonance imaging at term age can accurately determine the risk of cerebral palsy. The present study aimed to assess whether 11 motor and postural patterns concomitant with GMs were associated with cerebral palsy. Video recordings performed after birth in 79 preterm infants were reviewed retrospectively. Thirty-seven infants developed cerebral palsy at 2 years corrected age and the remaining 42 showed typical development. GMs were assessed from preterm to fidgety age and GM trajectories were defined. The 11 motor and postural patterns were evaluated at each age and longitudinally, alone and in combination with GM trajectories. A logistic regression model was used to assess the association between GMs, concomitant motor and postural patterns, and cerebral palsy. We confirmed that high-risk GM trajectories were associated with cerebral palsy (odds ratio = 44.40, 95% confidence interval = 11.74-167.85). An association between concomitant motor and postural patterns and cerebral palsy was found for some of the patterns at term age and for all of them at fidgety age. Therefore, at term age, concomitant motor and postural patterns can support GMs for the early diagnosis of cerebral palsy.
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Affiliation(s)
- Fabrizio Ferrari
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Carlotta Plessi
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy.
| | - Laura Lucaccioni
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Natascia Bertoncelli
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Luca Bedetti
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Luca Ori
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Alberto Berardi
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Elisa Della Casa
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Roberto D'Amico
- Statistic Unit, Department of Medical and Surgical Sciences, University of Modena, 41124 Modena, Italy
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Wang Y, Wu Y, Li T, Wang X, Zhu C. Iron Metabolism and Brain Development in Premature Infants. Front Physiol 2019; 10:463. [PMID: 31105583 PMCID: PMC6494966 DOI: 10.3389/fphys.2019.00463] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 04/04/2019] [Indexed: 12/12/2022] Open
Abstract
Iron is important for a remarkable array of essential functions during brain development, and it needs to be provided in adequate amounts, especially to preterm infants. In this review article, we provide an overview of iron metabolism and homeostasis at the cellular level, as well as its regulation at the mRNA translation level, and we emphasize the importance of iron for brain development in fetal and early life in preterm infants. We also review the risk factors for disrupted iron metabolism that lead to high risk of developing iron deficiency and subsequent adverse effects on neurodevelopment in preterm infants. At the other extreme, iron overload, which is usually caused by excess iron supplementation in iron-replete preterm infants, might negatively impact brain development or even induce brain injury. Maintaining the balance of iron during the fetal and neonatal periods is important, and thus iron status should be monitored routinely and evaluated thoroughly during the neonatal period or before discharge of preterm infants so that iron supplementation can be individualized.
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Affiliation(s)
- Yafeng Wang
- Department of Neonatology (NICU), Children’s Hospital Affiliated Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Clinical Neuroscience, Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Yanan Wu
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tao Li
- Department of Neonatology (NICU), Children’s Hospital Affiliated Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Clinical Neuroscience, Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Xiaoyang Wang
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Physiology, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury, Institute of Neuroscience and Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Clinical Neuroscience, Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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38
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Kepenek-Varol B, Tanrıverdi M, İşcan A, Alemdaroğlu-Gürbüz İ. The acute effects of physiotherapy on general movement patterns in preterm infants: A single-blind study. Early Hum Dev 2019; 131:15-20. [PMID: 30798037 DOI: 10.1016/j.earlhumdev.2019.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/27/2018] [Accepted: 02/13/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The General Movement Assessment (GMA) is a video analysis method developed by Heinz Prechtl that examines the infant's spontaneous movements. In recent years, although many studies have been performed in preterm infants by applying GMA, few studies have shown the effects of early intervention on GMA. AIMS Current study was planned to determine the acute effects of a single-session early physiotherapy approach on preterm infants' general spontaneous movements, and to reveal the change in Motor Optimality Scale (MOS) score including FMs. STUDY DESIGN Prospective, single-blind study. SUBJECTS Current study was carried out with 32 preterm infants at postterm 12-16 weeks. OUTCOME MEASURES The infants included in the study were videotaped by a physiotherapist during 10-15 min before the physiotherapy session at postterm 12-16 weeks for GMA. After a single physiotherapy session, the same physiotherapist performed the same video footage second time. A blind evaluator assessed the videos taken before and after session and scored Motor Optimality Scale (MOS). RESULTS AND CONCLUSIONS There was no statistically significant difference between MOS sub-category and total score of the infants before and after the session (p > 0.05). According to the results of present study, a single-session early physiotherapy intervention did not have an acute effect on the spontaneous movements of preterm infants at postterm 12-16 weeks. Future studies are needed to demonstrate the short and long-term effects of early physiotherapy approaches to risky infants.
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Affiliation(s)
- Büşra Kepenek-Varol
- Nuh Naci Yazgan University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Kayseri, Turkey
| | - Müberra Tanrıverdi
- Bezmialem Vakıf University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, İstanbul, Turkey.
| | - Akın İşcan
- Bezmialem Vakıf University, Faculty of Medicine, Pediatric Neurology Department, İstanbul, Turkey
| | - İpek Alemdaroğlu-Gürbüz
- Hacettepe University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Ankara, Turkey.
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Mongerson CRL, Wilcox SL, Goins SM, Pier DB, Zurakowski D, Jennings RW, Bajic D. Infant Brain Structural MRI Analysis in the Context of Thoracic Non-cardiac Surgery and Critical Care. Front Pediatr 2019; 7:315. [PMID: 31428593 PMCID: PMC6688189 DOI: 10.3389/fped.2019.00315] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/11/2019] [Indexed: 01/20/2023] Open
Abstract
Objective: To determine brain magnetic resonance imaging (MRI) measures of cerebrospinal fluid (CSF) and whole brain volume of full-term and premature infants following surgical treatment for thoracic non-cardiac congenital anomalies requiring critical care. Methods: Full-term (n = 13) and pre-term (n = 13) patients with long-gap esophageal atresia, and full-term naïve controls (n = 19) < 1 year corrected age, underwent non-sedated brain MRI following completion of thoracic non-cardiac surgery and critical care treatment. Qualitative MRI findings were reviewed and reported by a pediatric neuroradiologist and neurologist. Several linear brain metrics were measured using structural T1-weighted images, while T2-weighted images were required for segmentation of total CSF and whole brain tissue using the Morphologically Adaptive Neonatal Tissue Segmentation (MANTiS) tool. Group differences in absolute (mm, cm3) and normalized (%) data were analyzed using a univariate general linear model with age at scan as a covariate. Mean normalized values were assessed using one-way ANOVA. Results: Qualitative brain findings suggest brain atrophy in both full-term and pre-term patients. Both linear and volumetric MRI analyses confirmed significantly greater total CSF and extra-axial space, and decreased whole brain size in both full-term and pre-term patients compared to naïve controls. Although linear analysis suggests greater ventricular volumes in all patients, volumetric analysis showed that normalized ventricular volumes were higher only in premature patients compared to controls. Discussion: Linear brain metrics paralleled volumetric MRI analysis of total CSF and extra-axial space, but not ventricular size. Full-term infants appear to demonstrate similar brain vulnerability in the context of life-saving thoracic non-cardiac surgery requiring critical care as premature infants.
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Affiliation(s)
- Chandler R L Mongerson
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Sophie L Wilcox
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Stacy M Goins
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Danielle B Pier
- Massachusetts General Hospital Child Neurology, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
| | - Russell W Jennings
- Harvard Medical School, Harvard University, Boston, MA, United States.,Department of Surgery, Boston Children's Hospital, Boston, MA, United States
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Massachusetts General Hospital Child Neurology, Boston, MA, United States
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40
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Early neonatal morbidities and neurological functioning of preterm infants 2 weeks after birth. J Perinatol 2018; 38:1518-1525. [PMID: 30177861 DOI: 10.1038/s41372-018-0211-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/02/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the association between potential neonatal risk factors and the quality of general movements (GMs) in preterm infants. STUDY DESIGN Prospective cohort study in 67 preterm infants. From video recordings made on Days 8 and 15, we scored the GMs as normal/abnormal and detailed aspects using the general movement optimality score (GMOS). Risk factors included respiratory insufficiency requiring mechanical ventilation, patent ductus arteriosus (PDA), and abnormal blood glucose levels. We used multiple regression analyses. RESULT On Day 8 after birth, the presence of a PDA remained in the multivariable model, explaining 17.1% of the variance in GMOS (beta, -0.414). On Day 15, duration of mechanical ventilation and frequency of hypoglycemic episodes explained 38.8% of the variance (betas, -0.382 and -0.466, respectively). CONCLUSION In preterm infants, PDA, duration of mechanical ventilation, and frequency of hypoglycemic episodes were associated with poorer neurological functioning during the first 2 weeks after birth.
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41
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Sharp M, Coenen A, Amery N. General movement assessment and motor optimality score in extremely preterm infants. Early Hum Dev 2018; 124:38-41. [PMID: 30138737 DOI: 10.1016/j.earlhumdev.2018.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/08/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
Studies on general movement assessments (GMs) have included small numbers of extremely preterm (EP) infants. We determined the GMs and motor optimality score (MOS) of 40 EP infants. Poor repertoire at writhing age normalising to fidgety movements was the most common finding. MOS was lower than for published term infants.
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Affiliation(s)
- Mary Sharp
- Neonatal Directorate, King Edward Memorial Hospital, Subiaco, Western Australia, Australia; Centre for Neonatal Research & Education, UWA School of Paediatrics and Child Health, Western Australia, Australia.
| | - Arlette Coenen
- Neonatal Directorate, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Natasha Amery
- Neonatal Directorate, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
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42
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Hutchon B. Minor neurological dysfunction and other comorbidities in children born extremely preterm. Dev Med Child Neurol 2018; 60:737-738. [PMID: 29732555 DOI: 10.1111/dmcn.13905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dostanic T, Sustersic B, Paro-Panjan D. Developmental outcome in a group of twins: Relation to perinatal factors and general movements. Eur J Paediatr Neurol 2018; 22:682-689. [PMID: 29709428 DOI: 10.1016/j.ejpn.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The quality of general movements (GMs) has proven to have predictive value for the developmental outcome, but this has not yet been studied in twins. AIMS Our aim was to analyse the quality of GMs and neurological and developmental outcome in relation to the gestational age (GA), mode of conception and other perinatal risk factors in a group of twins. STUDY DESIGN The documentation of twins referred for follow-up in the period from 1998 to 2016 was studied retrospectively. Data concerning the quality of GMs, perinatal risk factors and developmental outcome were analysed. SUBJECTS Eighty-nine twin pairs, GA from 24 to 38 weeks (median 35.0; IQR 3), birth weight 670 g-3820 g (median 2323; IQR 645) were included. OUTCOME MEASURES Results of neurological, psychological and speech/language development and school outcome were analysed. RESULTS GMs at term age and at three to four months postterm age did not differ with regard to the mode of conception. Preterm birth was significantly related to GMs at three to four months postterm age. At term age, GMs were significantly related to neurological outcome, while at three to four months postterm age, GMs were related to both the neurological and psychological outcome. Difficulties in speech/language development were diagnosed in almost half of the children, more frequently in boys and children with lower Apgar scores. CONCLUSION The study highlights the value of GMs for predicting the developmental outcome in twins and indicates the importance of developmental, especially speech/language, follow-up in twins.
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Affiliation(s)
- Tamara Dostanic
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Bohoriceva 20, 1000, Ljubljana, Slovenia
| | - Breda Sustersic
- Developmental Clinic, Health Centre Domzale, Mestni Trg 2, 1230, Domzale, Slovenia
| | - Darja Paro-Panjan
- Department of Neonatology, Division of Paediatrics, University Medical Centre Ljubljana, Bohoriceva 20, 1000, Ljubljana, Slovenia.
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44
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Kwong AKL, Fitzgerald TL, Doyle LW, Cheong JLY, Spittle AJ. Predictive validity of spontaneous early infant movement for later cerebral palsy: a systematic review. Dev Med Child Neurol 2018; 60:480-489. [PMID: 29468662 DOI: 10.1111/dmcn.13697] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
AIM To systematically review the predictive validity of spontaneous early infant movements for later cerebral palsy (CP). METHOD Cohort studies with published data to calculate predictive validity of early spontaneous movements for later CP were searched in four electronic databases: CINAHL, Embase, MEDLINE, and PsycINFO. RESULTS Forty-seven studies met inclusion criteria. The Prechtl General Movements Assessment (GMA) during the fidgety period (10-20wks corrected age) had the strongest sensitivity: 97 per cent (95% confidence interval [CI] 93-99) and specificity: 89% (95% CI 83-93). The sensitivity and specificity of the Prechtl GMA during the writhing period (birth-6wks) was 93% (95% CI 86-96) and 59% (95% CI 45-71) respectively. Cramped-synchronized movements in the writhing period according to Prechtl had the best specificity (sensitivity: 70% [95% CI 54-82]; specificity: 97% [95% CI 74-100]). Hadders-Algra's method of assessing general movements had a pooled sensitivity and specificity of 89% (95% CI 66-97) and 81% (95% CI 64-91) respectively. Presence of asymmetric postures and movement quality/quantity were reported under the Hammersmith Infant Neurological Examination, Hammersmith Neonatal Neurological Examination, and Movement Assessment of Infants but had weak associations with later CP. INTERPRETATION Fidgety movements assessed by the Prechtl GMA have the strongest predictive validity for later CP, but cannot be considered in isolation because of the presence of false positive results. WHAT THIS PAPER ADDS Fidgety general movements (Prechtl) are most predictive for later cerebral palsy compared with other spontaneous movements. False positive results are high among all spontaneous movement assessments.
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Affiliation(s)
- Amanda K L Kwong
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Tara L Fitzgerald
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Jeanie L Y Cheong
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Alicia J Spittle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia
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45
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Tacke U, Weigand-Brunnhölzl H, Hilgendorff A, Giese RM, Flemmer AW, König H, Warken-Madelung B, Arens M, Hesse N, Schroeder AS. [Developmental neurology - networked medicine and new perspectives]. DER NERVENARZT 2017; 88:1395-1401. [PMID: 29101526 DOI: 10.1007/s00115-017-0436-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Developmental neurology is one of the major areas of neuropediatrics and is among other things (legally) responsible for monitoring the motor, cognitive and psychosocial development of all infants using standardized monitoring investigations. The special focus is on infants born at risk and/or due to premature birth before 32 weeks of gestation or a birth weight less than 1500 g. Early diagnosis of deviations from normal, age-related development is a prerequisite for early interventions, which may positively influence development and the long-term biopsychosocial prognosis of the patients. This article illustrates the available methods in developmental neurology with a focus on recent developments. Particular attention is paid to the predictive value of general movements (GM). The current development of markerless automated detection of spontaneous movements using conventional depth imaging cameras is demonstrated. Differences in spontaneous movements in infants at the age of 12 weeks are illustrated and discussed exemplified by three patients (healthy versus genetic syndrome versus cerebral palsy).
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Affiliation(s)
- U Tacke
- Abteilung für Neuropädiatrie und Entwicklung, Universitäts-Kinderspital beider Basel (UKBB), Spitalstraße 33, Postfach, 4031, Basel, Schweiz.
| | - H Weigand-Brunnhölzl
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland
| | - A Hilgendorff
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland.,Institut für Lungenbiologie Comprehensive Pneumology Center (CPC), Helmholz-Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, München, Deutschland
| | - R M Giese
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland
| | - A W Flemmer
- Neonatologie der Kinderklinik am Perinatalzentrum, Klinikum der LMU-München, Campus Großhadern, München, Deutschland
| | - H König
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland
| | - B Warken-Madelung
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland
| | - M Arens
- Fraunhofer Institut für Optronik, Systemtechnik und Bildauswertung (IOSB), Ettlingen, Deutschland
| | - N Hesse
- Fraunhofer Institut für Optronik, Systemtechnik und Bildauswertung (IOSB), Ettlingen, Deutschland
| | - A S Schroeder
- Abteilung für Pädiatrische Neurologie und Entwicklungsneurologie LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, München, Deutschland
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Abstract
PURPOSE To examine concurrent and predictive validity of the optimality list "Detailed Assessment of General Movements (GMs) During Preterm and Term Age." METHODS Video clips of general movements were analyzed for 20 infants born preterm without severe brain lesions. Concurrent validity of the optimality list compared with the General Movement Assessment (GMA) was examined. The General Movement Optimality Scores (GMOSs) between infants with normal and poor repertoire GMA were examined. Estimates of diagnostic accuracy were calculated. RESULTS The GMOS correlated with the GMA and differed between infants with normal and poor repertoire GMA. The area under the curve was below 0.53 with respect to normal or abnormal general movements at 3 months' corrected age. CONCLUSIONS Concurrent validity of the optimality list was moderate to high compared with the GMA, but its predictive validity for general movements at 3 months' corrected age was low.
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Salavati S, Einspieler C, Vagelli G, Zhang D, Pansy J, Burgerhof JGM, Marschik PB, Bos AF. The association between the early motor repertoire and language development in term children born after normal pregnancy. Early Hum Dev 2017; 111:30-35. [PMID: 28549271 PMCID: PMC5951278 DOI: 10.1016/j.earlhumdev.2017.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/03/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The assessment of the early motor repertoire is a widely used method for assessing the infant's neurological status. AIM To determine the association between the early motor repertoire and language development. STUDY DESIGN Prospective cohort study. SUBJECTS 22 term children born after normal pregnancy; video recorded for the assessment of the early motor repertoire including their motor optimality score (MOS), according to Prechtl, at 3 and 5months post term. OUTCOME MEASURES At 4years 7months and 10years 5months, we tested the children's language performance by administering three tests for expressive language and two for receptive language. RESULTS Smooth and fluent movements at 3months of age was associated with better expressive language outcome at both 4years 7months and 10years 5months (betas 0.363 and 0.628). A higher MOS at 5months was associated with better expressive language at both ages (betas 0.486 and 0.628). The item postural patterns at 5months was the only aspect associated with poorer expressive language outcome (beta -0.677). CONCLUSION Predominantly, qualitative aspects of the early motor repertoire at the age of 3 and 5months are associated with language development.
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Affiliation(s)
- Sahar Salavati
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria.
| | - Christa Einspieler
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria
| | - Giulia Vagelli
- SMILE Lab, Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Dajie Zhang
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria
| | - Jasmin Pansy
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter B Marschik
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria; Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ferrari F, Frassoldati R, Berardi A, Di Palma F, Ori L, Lucaccioni L, Bertoncelli N, Einspieler C. The ontogeny of fidgety movements from 4 to 20weeks post-term age in healthy full-term infants. Early Hum Dev 2016; 103:219-224. [PMID: 27825041 DOI: 10.1016/j.earlhumdev.2016.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/04/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fidgety movements (FMs) are an early accurate marker for normal development. AIM The study assessed the ontogeny of normal FMs from 4 to 20weeks post-term age (PTA). STUDY DESIGN Longitudinal prospective study of healthy full-term infants video recorded every second week from birth to 20weeks PTA. SUBJECTS 21 full-term newborns were enrolled. OUTCOME MEASURES Temporal organization, amplitude, character, predominance in proximal and/or distal parts of the body and the presence of FMs in fingers and wrists were independently scored by three observers. RESULTS From 4 to 10weeks PTA, FMs were sporadic, becoming intermittent in 1-2weeks; they occurred in the proximal parts, with larger and jerkier movements in the following period. From 11 to 16weeks PTA FMs became smaller in amplitude and slower in speed, they were present in all body parts and were more continual than before. Rotational movements in wrists and ankles and finger movements with open hands appeared. From 17 to 20weeks PTA, FMs became more discontinuous and disappeared at 18-20weeks PTA. CONCLUSIONS Developmental course of FMs was seen between 4 and 20weeks PTA with changes in temporal organization, amplitude, speed and body parts involved. The best time for scoring FMs is between 12 and 16weeks PTA.
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Affiliation(s)
- Fabrizio Ferrari
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Rossella Frassoldati
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Di Palma
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | - Luca Ori
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Natascia Bertoncelli
- Neonatal Intensive Care Unit, , Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Christa Einspieler
- Research Unit iDN - Interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Graz, Austria
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Adde L, Thomas N, John HB, Oommen S, Vågen RT, Fjørtoft T, Jensenius AR, Støen R. Early motor repertoire in very low birth weight infants in India is associated with motor development at one year. Eur J Paediatr Neurol 2016; 20:918-924. [PMID: 27524392 DOI: 10.1016/j.ejpn.2016.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/04/2016] [Accepted: 07/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most studies on Prechtl's method of assessing General Movements (GMA) in young infants originate in Europe. AIM To determine if motor behavior at an age of 3 months post term is associated with motor development at 12 months post age in VLBW infants in India. METHODS 243 VLBW infants (135 boys, 108 girls; median gestational age 31wks, range 26-39wks) were video-recorded at a median age of 11wks post term (range 9-16wks). Certified and experienced observers assessed the videos by the "Assessment of Motor Repertoire - 2-5 Months". Fidgety movements (FMs) were classified as abnormal if absent, sporadic or exaggerated, and as normal if intermittently or continually present. The motor behaviour was evaluated by repertoire of co-existent other movements (age-adequacy) and concurrent motor repertoire. In addition, videos of 215 infants were analyzed by computer and the variability of the spatial center of motion (CSD) was calculated. The Peabody Developmental Motor Scales was used to assess motor development at 12 months. RESULTS Abnormal FMs, reduced age adequacy, and an abnormal concurrent motor repertoire were significantly associated with lower Gross Motor and Total Motor Quotient (GMQ, TMQ) scores (p < 0.05). The CSD was higher in children with TMQ scores <90 (-1SD) than in children with higher TMQ scores (p = 0.002). CONCLUSION Normal FMs (assessed by Gestalt perception) and a low variability of the spatial center of motion (assessed by computer-based video analysis) predicted higher Peabody scores in 12-month-old infants born in India with a very low birth weight.
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Affiliation(s)
- Lars Adde
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, 7491 Trondheim, Norway; Department of Physiotherapy, Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway.
| | - Niranjan Thomas
- Department of Neonatology, Christian Medical College, IDA Scudder Rd, Vellore, Tamil Nadu 632004, India.
| | - Hima B John
- Department of Neonatology, Christian Medical College, IDA Scudder Rd, Vellore, Tamil Nadu 632004, India.
| | - Samuel Oommen
- Department of Neonatology, Christian Medical College, IDA Scudder Rd, Vellore, Tamil Nadu 632004, India.
| | - Randi Tynes Vågen
- Department of Physiotherapy, Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway.
| | - Toril Fjørtoft
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, 7491 Trondheim, Norway; Department of Physiotherapy, Clinic of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway.
| | | | - Ragnhild Støen
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, P.O. Box 8905, 7491 Trondheim, Norway; Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital, P.O. Box 3250 Sluppen, 7006 Trondheim, Norway.
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50
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Zang FF, Yang H, Han Q, Cao JY, Tomantschger I, Krieber M, Shi W, Luo DD, Zhu M, Einspieler C. Very low birth weight infants in China: the predictive value of the motor repertoire at 3 to 5months for the motor performance at 12months. Early Hum Dev 2016; 100:27-32. [PMID: 27391870 PMCID: PMC5010039 DOI: 10.1016/j.earlhumdev.2016.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/05/2016] [Accepted: 03/18/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies on motor performance and its early markers are rare in China, especially in very low birth weight (VLBW) infants. OBJECTIVE Apart from the assessment of the inter-scorer agreement, we aimed to analyze to what extent the motor repertoire at 10 to 18weeks postterm was related to neonatal complications, and gross and fine motor performance at 12months after term. STUDY DESIGN Exploratory prospective study. SUBJECTS Seventy-four VLBW infants (58 males; mean gestational age=29weeks; mean birth weight=1252g). METHOD Five-minute video recordings were performed at 10 to 18weeks after term; fidgety movements and the concurrent motor patterns (resulting in a motor optimality score) were assessed according to the Prechtl general movements assessment (GMA). The gross and fine motor performance was assessed by means of the Peabody Developmental Motor Scales, second edition, at 12months. RESULTS Reliability was excellent. Pneumonia was associated with absent fidgety movements; the motor optimality score was lower in infants with pneumonia and/or bronchopulmonary dysplasia. Both absent fidgety movements and a lower motor optimality score were associated with a poor or very poor gross and fine motor performance at the 12-month-assessment. CONCLUSION Both the assessment of fidgety movements and the evaluation of the concurrent motor repertoire contribute significantly to an identification of VLBW children with a poor gross and fine motor outcome at 12months. The results of this study document the need for an early identification of infants at high risk for a poor motor performance.
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Affiliation(s)
- Fei-Fei Zang
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Qian Han
- Health Service Center, Meilong Community, Minhang District, Shanghai, PR China
| | - Jia-Yan Cao
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Iris Tomantschger
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria
| | - Magdalena Krieber
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria
| | - Wei Shi
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Dan-Dan Luo
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Mo Zhu
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Christa Einspieler
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China.
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