Comparison between observation of spontaneous movements and neurologic examination in preterm infants*

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Objective: The Prechtl method of qualitative assessment of general movements (GMs) has been shown to be a good predictor of neurologic outcome in fetuses, preterm infants, and term infants. The aim of this study was to compare the results of this new technique with those of traditional neurologic examination and of cranial ultrasonography in preterm infants.

Methods: Serial videotape recordings (with off-line assessment of GMs), ultrasound examination of the brain, and neurologic examinations were performed from birth until about 6 months of corrected age, on a group of 66 preterm infants whose gestational age ranged from 26 to 36 weeks (mean 30.7 weeks). The agreement between the two techniques and their predictive power, with respect to the neurologic outcome at 2 years of corrected age, were evaluated for five different age groups from preterm age to 65 weeks of postmenstrual age.

Results: Overall agreement of the neurologic and GM findings was 80.3% and st strongly age related (lower during the preterm and term periods and higher thereafter). At all ages the results of GM observation correlated highly with neurologic outcome; they showed higher sensitivity and specificity than the neurologic examination. This held true in particular before term age, when poor neurologic responses might be related to transient complications, and at term age, mainly because of infants with normal neurologic examination results but unfavorable outcome. During the preterm period the ultrasound results showed a better specificity and a lower sensitivity to outcome than GM findings.

Conclusions: The results of this study indicate that quality assessment of GMs should be added to traditional neurologic assessment, neuroimaging, and other tests of preterm infants for diagnostic and prognostic purposes.

Section snippets

Neurologic examination and follow-up until 2 years of age

During the preterm period and at term age, repeated neurologic examinations were performed according to the Dubowitz6 and Prechtl5 protocols, respectively. Development during the first 6 months after term was assessed on the same occasion as the recordings of spontaneous motility were made (see below), by means of the Amiel-Tison and Grenier examination22 or by use of the Touwen criteria.23 Later development was checked at 24 months of corrected age, when the infants were also tested by the

RESULTS

The main results obtained are reported in Tables II and III.

. Distribution of neurologic and GM findings and their agreement at the various age periods

Empty CellPreterm periodTerm agePostterm period
Postmenstrual age (wk)28-3738-4243-4748-5657-65
No. of cases6560616661
GM observation
Normal (%)30.833.337.742.449.2
Abnormal (%)69.266.762.357.650.8
Neurologic examination results
Normal (%)36.948.332.836.447.6
Abnormal (%)63.151.767.263.652.4
Agreement (%)72.974.278.783.192.6

. Predictive indexes of GM observation and

DISCUSSION

One of the aims of this study was to evaluate the concordance of neurologic findings and GM observations when executed at the same age in preterm infants. The limited diagnostic and prognostic value of neurologic examination during the preterm and term periods might explain why the overall agreement between the two techniques was found to be fair and strongly age related.

In the first weeks after birth, physical conditions (e.g., anemia, jaundice, apneas, cardiac instability) may account for

Acknowledgements

We thank Prof. C. Cipolloni and the staff of the neonatal intensive care unit of the University of Pisa where some of the cases were observed. We also thank P. Morse for assistance with the English version of the manuscript and P. Magni for the illustration.

References (34)

  • M. Hadders-Algra

    General movements in early infancy: What do they tell us about the nervous system?

    Early Hum Dev

    (1993)
  • JJ. Volpe

    Brain injury in the premature infant: current concepts of pathogenesis and prevention

    Biol Neonate

    (1992)
  • SE Keeney et al.

    Prospective observations of 100 high-risk neonates by high-field (1.5 tesla) magnetic resonance imaging of the central nervous system: I. Intraventricular and extracerebral lesions

    Pediatrics

    (1991)
  • SE Keeney et al.

    Prospective observations of 100 high-risk neonates by high-field (1.5 tesla) magnetic resonance imaging of the central nervous system: II. Lesions associated with hypoxic-ischemic encephalopathy

    Pediatrics

    (1991)
  • HFR. Prechtl
    (1977)
  • LMS Dubowitz et al.
    (1981)
  • MEC Bierman-van Eendenburg et al.

    Predictive value of neonatal neurological examination: a follow-up study at 18 months

    Dev Med Child Neurol

    (1981)
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    *

    Supported in part by grants from the Italian Ministries of Health and of Scientific Research and Universities.

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