Predictive value of assessment of general movements for neurological development of high-risk preterm infants: comparative study

Abstract

Aim: To assess the predictive value of normal, abnormal, or absent general movements in high-risk preterm infants for the later neurological development.

Methods: The study involved 120 high-risk preterm infants (gestational age, < or =37 weeks) having at least three or more antenatal, perinatal, or neonatal risk factors for impaired neurological development, and 112 age-matched controls. The method of general movements of fidgety character assessment was compared with classical neurological examinations performed longitudinally until the corrected age of two years. The age-adequate neurological examinations based on the criteria by Amiel-Tison and Grenier and Illingworth were used. Specialists in clinical psychology also monitored the child's development. The results of specialists' examinations were taken into account.

Results: Out of 83 high-risk preterm infants with normal fidgety movements, 81 (97%) had a normal neurological outcome. Abnormal or absent fidgety movements were followed by abnormal neurological outcome in 30 (81%) out of 37 infants. Cerebral palsy was diagnosed in 13 children, mental retardation in one, whereas 16 children had both cerebral palsy and mental retardation. The validity of the general movement assessment was 92%, sensitivity 94%, specificity 92%, positive predictive value 81%, and negative predictive value 98%. These values were better than those of the classical neurologic examination (60%, 97%, 43%, 44%, and 97%, respectively).

Conclusion: The method of general movement assessment had significantly better validity, sensitivity, specificity, positive, and negative predictive value than classical neurological examination of high-risk preterm infants.