The quality of general movements in the first ten days of life in preterm infants

Abstract 

Background

The assessment of the quality of general movements (GMs) in preterm infants early in life has been used mainly to determine temporary or permanent neurological dysfunction and not to predict outcome.

Aim

Assessing the quality and evolution of GMs during the first ten days of life in preterm infants, and relating them to clinical factors and neurological outcome at 24months' post-term.

Methods

Using Prechtl's method, the GM quality was assessed in 45 preterm infants on days 2, 4, 6 and 10. They were related to clinical factors and outcome. After GM assessment, an extra item was scored: chaotic features (ChF). ChF was defined as chaotic GMs or poor repertoire GMs+chaotic movements.

Results

Abnormal GMs were seen mostly in early recordings. A better GM trajectory correlated with a higher birth weight, a higher gestational age and a lower Nursery Neurobiologic Risk Score (NBRS). Predictive value for normal outcome of at least one normal GM was 94%. Predictive value for abnormal outcome of only abnormal GMs was 21%. ChF were seen mostly in early recordings. Occurrence of ChF on day 2 correlated with lower serum calcium.

Conclusions

Preterm infants often showed abnormal GMs during the first few days. This was related mostly to a higher NBRS. Normalization of GMs during the first ten days was associated with a lower NBRS and was a reliable predictor for neurological outcome. ChFs could be a GM quality that is associated to lower calcium, indicating hyperexcitability of the nervous system.

Abbreviations: A, abnormal, BW, birth weight, Ch, chaotic, ChF(s), chaotic feature(s), CS, cramped-synchronized, ELBW, extremely low birth weight infants, GA, gestational age, GM(s), general movement(s), H, hypokinetic, IVH, intraventricular hemorrhage, LR, likelihood ratio, N, normal, NBRS, Nursery Neurobiologic Risk Score, NICU, Neonatal Intensive Care Unit, PVL, periventricular leucomalacia, PR, poor repertoire, SD, standard deviation, SGA, small for gestational age

Keywords: General movements, Preterm, Chaotic movements, Outcome, Infants