Individual longitudinal neurodevelopmental trajectories of children treated with hypothermia for perinatal asphyxia from 3 months to 5 years of age

Dekkers, Lieke; Janssen, Anjo J.W.M.; Steiner, Katerina; Schaijk, Nienke Maas-van; Akkermans, Reinier; Swart, Bert de; Sanden, Maria Nijhuis-van der

doi:10.1016/j.ridd.2020.103659

Cited by 4 publications

(10 citation statements)

References 32 publications

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“…To our knowledge, only 2 studies applying the General Movements Assessment in hypoxic-ischemic encephalopathy have been performed in the era of therapeutic hypothermia. Dekkers et al 24 utilized the General Movements Assessment as described by Hadders-Algra et al in a cohort of 18 children with hypoxic-ischemic encephalopathy, classifying movement as normal optimal, normal suboptimal, mildly abnormal, or definitely abnormal. 25 Ten infants (56%) had normal optimal or normal suboptimal findings on the General Movements Assessment.…”

Section: Discussionmentioning

confidence: 99%

“…Other recent studies in patients with hypoxic-ischemic encephalopathy do not include writhing age assessments. 20,24…”

Section: Discussionmentioning

confidence: 99%

“…The majority of studies report that the General Movements Assessment has high sensitivity and specificity for neurodevelopmental outcome and equal or better predictive value than EEG, neuroimaging, and neurologic examination. 6,18 -24 However, one long-term study raised concern about the General Movements Assessment’s predictive ability in term infants. Van Iersel et al 25 evaluated perinatal risk factors and the quality of writhing and fidgety general movements in term newborns with “difficult birth at term” from 1999 to 2005 and followed the cohort until 6 years of age.…”

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confidence: 99%

“…The authors found the sensitivity and specificity of the General Movements Assessment for 12-18-month neurodevelopmental outcome were 80%-83% and 67%-100%, respectively. Dekkers et al 24 analyzed the General Movements Assessment in 18 patients with moderate-severe hypoxic-ischemic encephalopathy who received therapeutic hypothermia and followed their developmental trajectories until 5 years of age. The correlation between the General Movements Assessment and motor outcome at 5 years of age was “good to excellent” (r s = 0.84, p < 0.01, 95% CI [0.4-1.0]).…”

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confidence: 99%

“…The correlation between the General Movements Assessment and motor outcome at 5 years of age was “good to excellent” (r s = 0.84, p < 0.01, 95% CI [0.4-1.0]). 24…”

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confidence: 99%

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The General Movements Assessment in Neonates With Hypoxic Ischemic Encephalopathy

et al. 2021

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Background: Clinical measures after birth and studies such as electroencephalogram (EEG) and brain imaging do not fully predict neurodevelopmental outcomes of infants with hypoxic-ischemic encephalopathy. Early detection of adverse neurologic outcomes, and cerebral palsy in particular, in high-risk infants is essential for ensuring timely management. The General Movements Assessment is a tool that can be used in the early detection of cerebral palsy in infants with brain injury. The majority of studies on the General Movements Assessment in the late preterm and term population were performed prior to the introduction of therapeutic hypothermia. Aims: To apply the General Movements Assessment in late preterm and term infants with hypoxic-ischemic encephalopathy (including those who received therapeutic hypothermia), to determine if clinical markers of hypoxic-ischemic encephalopathy predict abnormal General Movements Assessment findings, and to evaluate interrater reliability of the General Movements Assessment in this population. Study design: Pilot prospective cohort study Subjects: We assessed 29 late preterm and full-term infants with mild, moderate, and severe hypoxic-ischemic encephalopathy in Philadelphia, PA. Results: Most infants’ general movements normalized by the fidgety age. Only infants with moderate or severe hypoxic-ischemic encephalopathy had abnormal general movements in both the writhing and the fidgety ages (n = 6). Seizure at any point during the initial hospitalization was the clinical sign most predictive of abnormal general movements in the fidgety age (sensitivity 100%, specificity 55%, positive predictive value 40%, negative predictive value 100%). Interrater reliability was greatest during the fidgety age (κ = 0.67). Conclusions: Seizures were the clinical predictor most closely associated with abnormal findings on the General Movements Assessment. However, clinical markers of hypoxic-ischemic encephalopathy are not fully predictive of abnormal General Movements Assessment findings. Larger future studies are needed to evaluate the associations between the General Movements Assessment and childhood neurologic outcomes in patients with hypoxic-ischemic encephalopathy who received therapeutic hypothermia.

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Section: Discussionmentioning

confidence: 99%

“…Other recent studies in patients with hypoxic-ischemic encephalopathy do not include writhing age assessments. 20,24…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

“…The correlation between the General Movements Assessment and motor outcome at 5 years of age was “good to excellent” (r s = 0.84, p < 0.01, 95% CI [0.4-1.0]). 24…”

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confidence: 99%

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