Cathryn Crowle1, Claire Galea2, Catherine Morgan3, Iona Novak4, Karen Walker5, Nadia Badawi6. 1. Grace Centre for Newborn Care, The Children's Hospital Westmead, Sydney, Australia; University of Sydney, Sydney, Australia. Electronic address: Cathryn.crowle@health.nsw.gov.au. 2. Cerebral Palsy Alliance Research Institute, Sydney, Australia. Electronic address: cgalea@cerebralpalsy.org.au. 3. University of Sydney, Sydney, Australia; Cerebral Palsy Alliance Research Institute, Sydney, Australia. Electronic address: cmorgan@cerebralpalsy.org.au. 4. University of Sydney, Sydney, Australia; Cerebral Palsy Alliance Research Institute, Sydney, Australia. Electronic address: inovak@cerebralpalsy.org.au. 5. Grace Centre for Newborn Care, The Children's Hospital Westmead, Sydney, Australia; University of Sydney, Sydney, Australia; Cerebral Palsy Alliance Research Institute, Sydney, Australia. Electronic address: Karen.walker@health.nsw.gov.au. 6. Grace Centre for Newborn Care, The Children's Hospital Westmead, Sydney, Australia; University of Sydney, Sydney, Australia; Cerebral Palsy Alliance Research Institute, Sydney, Australia. Electronic address: nadia.badawi@health.nsw.gov.au.
Abstract
BACKGROUND: The General Movements Assessment (GMA) is a validated and reliable method of identifying infants at risk of adverse neurodevelopmental outcomes, however there is minimal data available on the use of the GMA with infants following surgery. AIMS: The aim of this study was to investigate the inter-observer agreement for the GMA with this infant population. STUDY DESIGN: Reliability and agreement study. SUBJECTS: This was a prospective cohort study of 190 infants (male n=112) born at term (mean 38weeks, SD 2weeks). OUTCOME MEASURES: A GMA was conducted in the Neonatal Intensive Care Unit (NICU) following either cardiac surgery (n=92), non-cardiac surgery (n=93) or both types of surgery (n=5), and then again at three months of age. All videos were independently assessed by three advanced trained clinicians. Agreement and reliability statistics were calculated between each pair. RESULTS: We found moderate to substantial levels of agreement in the writhing period (66-77%, AC1=0.53-0.69). For fidgety general movements, agreement was classified as almost perfect, ranging from 86 to 89% (AC1=0.84-0.88). CONCLUSIONS: The GMA has high levels of inter-observer agreement when used with infants who have undergone surgery in the neonatal period, making it a valid, complementary assessment tool. Research is now underway to determine the ability of the GMA to predict neurodevelopmental outcomes in this population.
BACKGROUND: The General Movements Assessment (GMA) is a validated and reliable method of identifying infants at risk of adverse neurodevelopmental outcomes, however there is minimal data available on the use of the GMA with infants following surgery. AIMS: The aim of this study was to investigate the inter-observer agreement for the GMA with this infant population. STUDY DESIGN: Reliability and agreement study. SUBJECTS: This was a prospective cohort study of 190 infants (male n=112) born at term (mean 38weeks, SD 2weeks). OUTCOME MEASURES: A GMA was conducted in the Neonatal Intensive Care Unit (NICU) following either cardiac surgery (n=92), non-cardiac surgery (n=93) or both types of surgery (n=5), and then again at three months of age. All videos were independently assessed by three advanced trained clinicians. Agreement and reliability statistics were calculated between each pair. RESULTS: We found moderate to substantial levels of agreement in the writhing period (66-77%, AC1=0.53-0.69). For fidgety general movements, agreement was classified as almost perfect, ranging from 86 to 89% (AC1=0.84-0.88). CONCLUSIONS: The GMA has high levels of inter-observer agreement when used with infants who have undergone surgery in the neonatal period, making it a valid, complementary assessment tool. Research is now underway to determine the ability of the GMA to predict neurodevelopmental outcomes in this population.