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Predicting abnormal motor outcome in very preterm infants at 12 months:the role of qualitative MRI and general movement assessments

A SPITTLE A, B, E, R BOYD A,B,D, T E INDER A, LW DOYLE A,B,C,E

  1. 1. Murdoch Childrens Research Institute;
  2. 2. Department of Paediatrics;
  3. 3. Department of Obstetrics and Gynacology University of Melbourne;
  4. 4. School of Physiotherapy, La Trobe University;
  5. 5. Royal Women’s Hospital, Melbourne, Australia

Background: General Movements (GMs) assessments are reported to be more valid than neurological examination and cranial ultrasound in predicting the long-term outcome of preterm infants. However, advances in neonatal magnetic resonance imaging (MRI) have also improved prediction of outcome.

Objective: To compare qualitative MRI of brain structure at term equivalent age and GMs assessments at 1 and 3 months’ corrected age in predicting motor outcome at 1 year corrected age in very preterm infants.

Design: Prospective cohort study.

Setting: Two neonatal intensive care units.

Participants: Preterm infants born at <30 weeks’ gestation without major congenital anomalies.

Method: Infants had MRI at term equivalent age (1.5-Tesla GE scanner). White matter abnormality (WMA) was scored as nilminimal or moderate-severe by an neonatalogist. Standarized videotaped recordings of GMs were obtained at 1 and 3 months postterm. At 1 month GMs of a writhing character were classified as normal or abnormal (poor repertoire, cramped synchronized, or chaotic). At 3 months the GMs changed character to fidgety GMs, classified as normal or abnormal. Motor outcome was assessed at 1 year corrected age using the Alberta Infant Motor Scale (AIMS) with a score <_5th centile classified as abnormal, minimal, or abnormal. All assessors were blinded to the results of other assessments. Correlation between GMs, WMA, and the 1-year outcomes (AIMS and NSMDA) were assessed using Spearman’s rank correlation coefficient ®.

Results: To date, 25 infants have completed the study. At 12 months the AIMS categorized 11 (44%) as abnormal; and the NSMDA categorized 11 (44%) with minimal motor problems and five (20%) with abnormal motor development. Abnormal AIMS scores were related to the presence of moderate to severe WMA at term and abnormal GMs at 1 month, whereas minimal and abnormal motor problems on NSDMA were associated with WMA and GMs at both 1 and 3 months (Table B:5).

Conclusion: White matter abnormalities on MRI and GMs assessments are both predictive of motor outcome at 12 months. Functional examinations should have an important role in predicting long-term motor outcome.

 
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