Predictive value of General Movement Assessment for preterm infants' development at 2 years - implementation in clinical routine in a non-academic setting.

Res Dev Disabil 2017 Mar 20;62:69-80. Epub 2017 Jan 20.

Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany.

Background: General movements (GM) are used in academic settings to predict developmental outcome in infants born preterm. However, little is known about the implementation and predictive value of GM in non-academic settings.

Aims: The aim of this study is twofold: To document the implementation of GM assessment (GMA) in a non-academic setting and to assess its predictive value in infants born preterm.

Methods And Procedures: We documented the process of implementing GMA in a non-academic outpatient clinic. In addition, we assessed the predictive value of GMA at 1 and 3 months' corrected age for motor and cognitive development at 2 years in 122 children born <33 weeks' gestation. Outcome at two years was based upon the Bayley Scales of Infant Development-II (mental/psychomotor developmental index (MDI, PDI)) and a neurological examination. The infants' odds of atypical outcome (MDI or PDI ≤70 or diagnosis CP) and the predictive accuracy of abnormal GMA were calculated in a clinical routine scenario, which used all available GM information (primarily at 3 months or at 1 month, when 3 months were not available). In addition, separate analysis was undertaken for the samples of GMA at 1 and 3 months.

Outcomes And Results: Tips to facilitate GMA implementation are described. In our clinical routine scenario, children with definitely abnormal GM were more likely to have an atypical two-year outcome than children with normal GM (OR 13.2 (95% CI 1.56; 112.5); sensitivity 55.6%, specificity 82.1%). Definitely abnormal GM were associated with reduced MDI (-12.0, 95% CI -23.2; -0.87) and identified all children with cerebral palsy (CP) in the sample of GMA at 3 months only.

Conclusions And Implications: GMA can be successfully implemented in a non-academic outpatient setting. In our clinical routine scenario, GMA allowed for adequate prediction of neurodevelopment in infants born preterm, thereby allaying concerns about diagnostic accuracy in non-academic settings.

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Source
http://dx.doi.org/10.1016/j.ridd.2017.01.012DOI Listing
March 2017
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