Gunn Kristin Øberg1, Bjarne Koster Jacobsen2, Lone Jørgensen3. 1. G.K. Øberg, PT, PhD, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, MH Building, Breivika Tromsø 9037, Norway, and Department of Clinical Therapeutic Services, University Hospital of North Norway, Tromsø, Norway. gunn.kristin.oeberg@uit.no. 2. B.K. Jacobsen, MSc, PhD, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway. 3. L. Jørgensen, PT, PhD, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, and Department of Clinical Therapeutic Services, University Hospital of North Norway.
Abstract
BACKGROUND: Early identification of children at high risk of future neurodevelopmental disability is important for the initiation of appropriate therapy. In research settings, the assessment of fidgety movements (FMs) at 3 months supports a general movement assessment (GMA) as a strong predictor for subsequent motor development, but there are few studies from routine clinical settings. OBJECTIVE: The study objective was to examine the relationship between FMs and neurodevelopmental outcome by the age of 2 years in high-risk infants in a routine hospital clinical setting. DESIGN: This was a prospective study. METHODS: A GMA was performed in 87 high-risk infants at 3 months after term age. The infants were clinically assessed for cerebral palsy (CP) at 2 years. Sensitivity, specificity, likelihood ratios, and positive and negative predictive values were computed. The relative risk of motor problems by the age of 2 years, according to the GMA, was estimated. RESULTS: Of the infants with normal FMs, 93% (50/54) had normal development and none was diagnosed with CP, whereas 75% (12/16) with abnormal or sporadic FMs had normal development. In contrast, 53% (9/17) of those without FMs had CP. When the GMA was considered to be a test for CP and absent FMs were considered to be a positive test result, the sensitivity was 90% and the specificity was 90%. The likelihood ratios for positive and negative test results were 8.7 and 0.1, respectively. The negative predictive value was 99%, and the positive predictive value was 53%. The risk of motor problems by the age of 2 years increased linearly with the extent of pathological results on the GMA and was 10 times higher when FMs were absent at 3 months than when FMs were normal. LIMITATIONS: The relatively small study sample was a study limitation. CONCLUSIONS: When applied in a routine clinical setting, the GMA strongly predicted neurodevelopmental impairments at 2 years in high-risk infants.
BACKGROUND: Early identification of children at high risk of future neurodevelopmental disability is important for the initiation of appropriate therapy. In research settings, the assessment of fidgety movements (FMs) at 3 months supports a general movement assessment (GMA) as a strong predictor for subsequent motor development, but there are few studies from routine clinical settings. OBJECTIVE: The study objective was to examine the relationship between FMs and neurodevelopmental outcome by the age of 2 years in high-risk infants in a routine hospital clinical setting. DESIGN: This was a prospective study. METHODS: A GMA was performed in 87 high-risk infants at 3 months after term age. The infants were clinically assessed for cerebral palsy (CP) at 2 years. Sensitivity, specificity, likelihood ratios, and positive and negative predictive values were computed. The relative risk of motor problems by the age of 2 years, according to the GMA, was estimated. RESULTS: Of the infants with normal FMs, 93% (50/54) had normal development and none was diagnosed with CP, whereas 75% (12/16) with abnormal or sporadic FMs had normal development. In contrast, 53% (9/17) of those without FMs had CP. When the GMA was considered to be a test for CP and absent FMs were considered to be a positive test result, the sensitivity was 90% and the specificity was 90%. The likelihood ratios for positive and negative test results were 8.7 and 0.1, respectively. The negative predictive value was 99%, and the positive predictive value was 53%. The risk of motor problems by the age of 2 years increased linearly with the extent of pathological results on the GMA and was 10 times higher when FMs were absent at 3 months than when FMs were normal. LIMITATIONS: The relatively small study sample was a study limitation. CONCLUSIONS: When applied in a routine clinical setting, the GMA strongly predicted neurodevelopmental impairments at 2 years in high-risk infants.
Authors: Ragnhild Støen; Nils Thomas Songstad; Inger Elisabeth Silberg; Toril Fjørtoft; Alexander Refsum Jensenius; Lars Adde Journal: Pediatr Res Date: 2017-07-26 Impact factor: 3.756