The Baby Moves prospective cohort study protocol: using a smartphone application with the General Movements Assessment to predict neurodevelopmental outcomes at age 2 years for extremely preterm or extremely low birthweight infants

Abstract

IntroductionInfants born extremely preterm (EP; <28 weeks' gestation) and/or with extremely low birth weight (ELBW; <1000 g birth weight) are at increased risk for adverse neurodevelopmental outcomes. However, it is challenging to predict those EP/ELBW infants destined to have long-term neurodevelopmental impairments in order to target early intervention to those in most need. The General Movements Assessment (GMA) in early infancy has high predictive validity for neurodevelopmental outcomes in preterm infants. However, access to a GMA may be limited by geographical constraints and a lack of GMA-trained health professionals. Baby Moves is a smartphone application (app) developed for caregivers to video and upload their infant's general movements to be scored remotely by a certified GMA assessor. The aim of this study is to determine the predictive ability of using the GMA via the Baby Moves app for neurodevelopmental impairment in infants born EP/ELBW.Methods and analysisThis prospective cohort study will recruit infants born EP/ELBW across the state of Victoria, Australia in 2016 and 2017. A control group of normal birth weight (>2500 g birth weight), term-born (≥37 weeks' gestation) infants will also be recruited as a local reference group. Parents will video their infant's general movements at two time points between 3 and 4 months' corrected age using the Baby Moves app. Videos will be scored by certified GMA assessors and classified as normal or abnormal. Parental satisfaction using the Baby Moves app will be assessed via survey. Neurodevelopmental outcome at 2 years' corrected age includes developmental delay according to the Bayley Scales of Infant and Toddler Development-III and cerebral palsy diagnosis.Ethics and disseminationThis study was approved by the Human Research and Ethics Committees at the Royal Children's Hospital, The Royal Women's Hospital, Monash Health and Mercy Health in Melbourne, Australia. Study findings will be disseminated via peer-reviewed publications and conference presentations.

Predictive validity of spontaneous early infant movement for later cerebral palsy: a systematic review

“…The predictive validity of fidgety movements using the Prechtl GMA in this study is consistent with the results of previous reviews of the Prechtl GMA. 9,10 There was inconsistent reporting of studies' interpretation of pathological postures such as ATNR or limb movement quality, resulting in variable threshold levels that limited the ability to pool predictive validity of these postures. To our knowledge, this is the first systematic review to use meta-analysis to assess the predictive validity of writhing and fidgety movements under the Prechtl GMA and general movements according to Hadders-Algra separately, with Prechtl's method having better predictive validity for CP.…”

“…4 However, delaying intervention until the time of diagnosis may result in missed opportunities to implement intervention during a period of brain 'plasticity', and maximize functional outcomes from the earliest possible age. 8 With recent advances in smartphone technology, capturing spontaneous movements using video has improved accessibility, 9,10 which has the potential to provide remote professional assessments for isolated and vulnerable families. 8 With recent advances in smartphone technology, capturing spontaneous movements using video has improved accessibility, 9,10 which has the potential to provide remote professional assessments for isolated and vulnerable families.…”

The Baby Moves smartphone app for General Movements Assessment: Engagement amongst extremely preterm and term‐born infants in a state‐wide geographical study

“…The app was available for i‐operating system (iOS), version 7.0/8.0/9.0 (Apple Inc., Cupertino, CA, USA) and Android, version 4.2‐5.1 systems (Android Inc., Palo Alto, CA, USA). The app provided notifications at 12 and 14 weeks' corrected age to prompt parents to record GMs according to simple instructions . If infants were inpatients at 12–16 weeks' corrected age, parents were encouraged to record the video in the hospital setting.…”

“…Fidgety general movements (GMs) observed at 9–20 weeks' corrected age are spontaneous, small‐amplitude, variable movements in all four limbs and the body of an awake infant and have good predictive validity for later cerebral palsy (CP) . Our team designed a smartphone application (app), called Baby Moves , to enable parents to record videos of their infants' movements after being discharged from hospital with the aim of improving access to skilled clinicians for remote GMA and to ensure the timeliness of assessment during the fidgety period.…”

A Novel Way to Measure and Predict Development: A Heuristic Approach to Facilitate the Early Detection of Neurodevelopmental Disorders

“…Currently GMA is being used by an increasing number of health professionals around the world for assessment and identification of infants at high-risk for neurological impairments. With this in mind, we are developing a mobile solution allowing for broader application (the GMApp; www.gmapp.idn-research.org; [52]). More recently, complementary efforts have been taken to augment classic GMA, based on visual Gestalt perception, with computer-based movement assessment tools to perform quantitative analysis of GMs [53–57, 58•].…”