Toril Fjørtoft

Follow-up at age 10 years in ELBW children — Functional outcome, brain morphology and results from motor assessments in infancy ☆ ☆☆

BACKGROUND Extremely-low-birth-weight (ELBW) children without severe brain injury or CP are at high risk of developing deficits within cognition, attention, behavior and motor function. Assessing the quality of an infants spontaneous motor-repertoire included in Prechtls General-Movement-Assessment (GMA) has been shown to relate to later motor and cognitive functioning in preterm children without CP. AIMS To investigate functional outcome and cerebral MRI morphometry at 10 years in ELBW children without CP compared to healthy controls and to examine any relationship with the quality of infant-motor-repertoire included in the GMA. STUDY DESIGN A cohort-study-design. SUBJECTS 31 ELBW children (mean birth-weight: 773 g, SD 146, mean gestational age 26.1 weeks, SD 1.8) and 33 term-born, age-matched controls. OUTCOME MEASURES GMA was performed in ELBW children at 3 months corrected age. At 10 years the children underwent comprehensive motor, cognitive, behavioral assessments and cerebral MRI. RESULTS The non-CP ELBW children had similar full-IQ but poorer working memory, poorer motor skills, and more attentional and behavioral problems compared to controls. On cerebral MRI reduced volumes of globus pallidus, cerebellar white matter and posterior corpus callosum were found. Cortical surface-area was reduced in temporal, parietal and anterior-medial-frontal areas. Poorer test-results and reduced brain volumes were mainly found in ELBW children with fidgety movements combined with abnormal motor-repertoire in infancy. CONCLUSION Non-CP ELBW children have poorer functional outcomes, reduced brain volumes and cortical surface-area compared with term-born controls at 10 years. ELBW children with abnormal infant motor-repertoire seem to be at increased risk of later functional deficits and brain pathology.

Relationship between white matter pathology and performance on the General Movement Assessment and the Test of Infant Motor Performance in very preterm infants

BACKGROUND Cerebral Magnetic Resonance Imaging, the General Movement Assessment, and the Test of Infant Motor Performance are all tools that can predict neurodevelopmental outcome in preterm infants. However, how these tests relate to each other is unclear. AIMS To examine the relationship between cerebral Magnetic Resonance Imaging measured at term age, and the General Movement Assessment and Test of Infant Motor Performance measured at 10-15 weeks post-term age. STUDY DESIGN Prospectively collected data in a sample of very preterm infants. SUBJECTS Fifty-three infants (23 female, 30 male) with a median gestational age of 28 weeks (range: 23-30 weeks) and a median birth weight of 1000 g (range: 515-1465 g). OUTCOME MEASURES Test of Infant Motor Performance, General Movement Assessment. RESULTS Infants with abnormal white matter were significantly more likely to have both abnormal general movements (p=0.01) and abnormal Test of Infant Motor Performance scores (p=0.001). Infants with abnormal general movements were significantly more likely to have lower Test of Infant Motor Performance Scores (p=0.01). CONCLUSIONS Abnormal white matter is related to motor deviations as measured by the General Movement Assessment and the Test of Infant Motor Performance as early as 3 months post-term age in a cohort of preterm infants.

Does a parent-administrated early motor intervention influence general movements and movement character at 3 months of age in infants born preterm?

BACKGROUND Studies of preterm and term-born infants have shown absent fidgety movements and an abnormal movement character to be related to brain lesions and unfavourable neurological outcomes. AIMS The present study examines what effect a parent-administered early intervention program applied to preterm infants in a randomised control trial (RCT) between 34 and 36weeks gestational age has on their fidgety movements and overall movement character at three months of age. STUDY DESIGN The study was part of the RCT in an early intervention programme including preterm infants born between 2010 and 2014 at three Norwegian university hospitals. SUBJECTS 130 preterm infants participated in the study, with 59 of them in the control group and 71 in the intervention group. OUTCOME MEASURES Fidgety movements and overall movement character at three months corrected age. RESULTS No difference was found between the intervention group and the control group in terms of fidgety movements or movement character. Approximately half of the infants in both groups showed an abnormal movement character. CONCLUSION No evidence was found in this RCT to suggest that an intervention at 34 to 37weeks gestational age has a significant effect on the fidgety movements or overall movement character of preterm infants. This is in line with the assumption that absent fidgety movements and an abnormal movement character are due to permanent brain injury and are therefore good predictors for later neurological impairments.

Computer-based video analysis identifies infants with absence of fidgety movements.

BackgroundAbsence of fidgety movements (FMs) at 3 months’ corrected age is a strong predictor of cerebral palsy (CP) in high-risk infants. This study evaluates the association between computer-based video analysis and the temporal organization of FMs assessed with the General Movement Assessment (GMA).MethodsInfants were eligible for this prospective cohort study if referred to a high-risk follow-up program in a participating hospital. Video recordings taken at 10–15 weeks post term age were used for GMA and computer-based analysis. The variation of the spatial center of motion, derived from differences between subsequent video frames, was used for quantitative analysis.ResultsOf 241 recordings from 150 infants, 48 (24.1%) were classified with absence of FMs or sporadic FMs using the GMA. The variation of the spatial center of motion (CSD) during a recording was significantly lower in infants with normal (0.320; 95% confidence interval (CI) 0.309, 0.330) vs. absence of or sporadic (0.380; 95% CI 0.361, 0.398) FMs (P<0.001). A triage model with CSD thresholds chosen for sensitivity of 90% and specificity of 80% gave a 40% referral rate for GMA.ConclusionQuantitative video analysis during the FMs’ period can be used to triage infants at high risk of CP to early intervention or observational GMA.

Can Impaired Motor and Cognitive Functions at 10 Years of Age be Identified by a Detailed Analysis of Infant Motor Behaviour in Very-Low-Birth-Weight Children?

Background: The General Movement Assessment has mainly been used to identify children with cerebral palsy (CP). A more detailed analysis of infant motor behavior can possibly identify later motor and cognitive problems in children without CP.Aims: To determine whether such a detailed analysis of infant motor behaviour can predict motor and cognitive development in very-low-birth-weight children at age 10.Methods: Twenty-two infants without CP with mean gestational age 26.9 (SD2.0) wks; mean birth weight 888 grams (SD229) were included. Video-recordings were analyzed according to “Assessment of Motor Repertoire 3-5 Months”, which is part of Prechtl`s General Movement Assessment. Fidgety movements were classified as present or absent/abnormal. Quality of the whole motor repertoire was classified as normal if smooth and fluent and abnormal if jerky, monotonous or stiff. At age 10, poor outcome was defined as Movement Assessment Battery for Children-2 (MABC-2) score below the 5th percentile or a total IQ less than 85 on the Wechsler Intelligence Scale for Children (WISC-III).Results: Most children with poor motor outcome were identified by presence of fidgety, but abnormal motor repertoire, at 14 weeks post term (sensitivity: 0.83; 95%CI: 0.44-0.97). Sensitivity of presence of fidgety, but abnormal motor repertoire, for poor cognitive outcome was 0.50 (95%CI: 0.15-0.85). Specificity was 0.75 (95%CI: 0.51-0.90) and 0.61 (95%CI: 0.39-0.80) for normal motor and cognitive outcome, respectively.Conclusions: Presence of fidgety movements, but abnormal motor repertoire, may predict later impaired motor and to a lesser degree cognitive development in preterm children who do not develop CP.