The importance of assessing general motor activity in premature infants for predicting neurological outcomes.

ABSTRACT

INTRODUCTION: Conventional methods of neurological assessment of infants can detect nervous system damage, but also have a weakness, i.e., the inability to make predictions for neurological deficits. Prechtl's general movement assessment is a diagnostic tool for the functional assessment of young nervous system. The aim of the study was to assess the quality of spontaneous motor activity in preterm newborns as well as to determine the neurological outcome at the age of 24 months. After that, the predictive value of spontaneous motor activity for neuro-developmental outcome at the age of 24 months was determined. MATERIAL AND METHODS: The study included 160 pre-terms children, and designed as a prospective clinical study. Observation of spontaneous motor activity was performed according to the principles of Prechtl's method. RESULTS: Spontaneous motor activity was observed in three periods for each newborn within 5 days of birth, in the period of 44-46 gestation weeks, and in the period of 50-54 gestation weeks of post-menstrual age. Neurological outcome was assessed at the age of 24 months, and was classified as normal finding, minimal neurological dysfunction, and cerebral palsy. All preterms, who presented normal patterns of spontaneous movements in neonatal and infant periods had a normal neurological functional outcomes at the age of 24 months. Newborns with pathological patterns of movement (cramped synchronized and absence of fidgety movements) in neonate and infant periods in the final outcomes had minimal neurological dysfunction or cerebral palsy. CONCLUSIONS: Assessment of general movement in preterms is a valuable method in prediction of dysfunctions in later neurological development. Early detection of symptoms of minimal neurological deficit and cerebral palsy is of crucial importance since it enables timely inclusion of children into neuro-developmental treatment.