The Quality of the Early Motor Repertoire in Preterm Infants Predicts Minor Neurologic Dysfunction at School Age

Bruggink, Janneke L M; Einspieler, Christa; Butcher, Phillipa R.; Braeckel, Koenraad N.J.A. Van; Prechtl, H.F.R.; Bos, Arend F.

doi:10.1016/j.jpeds.2007.12.047

Cited by 114 publications

(115 citation statements)

References 35 publications

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“…12,13 Recent studies indicate that the degree of variability in motor behaviour is a sensitive marker of the integrity of the infant's brain. 9,[14][15][16][17] We determined reliability in terms of inter-assessor agreement and assessed construct and predictive validity. We restricted the evaluation of reliability to interassessor agreement because the assessment of intra-assessor agreement cannot be determined for a tool involving a number of hands-on techniques, such as the pull-to-sit manoeuvre, the assessment of muscle tone, tendon reflexes, and various reactions.…”

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confidence: 99%

The assessment of minor neurological dysfunction in infancy using the Touwen Infant Neurological Examination: strengths and limitations

Hadders‐Algra

Heineman

Bos

et al. 2009

Develop Med Child Neuro

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AIM Little is known of minor neurological dysfunction (MND) in infancy. This study aimed to evaluate the inter-assessor reliability of the assessment of MND with the Touwen Infant Neurological Examination (TINE) and the construct and predictive validity of MND in infancy.METHOD Inter-assessor agreement was determined in a sample of 40 infants (24 males, 16 females) aged 3 to 12 months (25 born at term: gestational age 37-41wks, median 39; and 15 born preterm, gestational age 24-35wks, median 32). Thirty typically developing term infants (18 males, 12 females; gestational age 37-42wks, median 40) and 59 preterm infants (34 males, 25 females) born at <35 weeks' gestation (gestational age 25-34wks, median 29) participated in the validity study. They were neurologically assessed with the TINE at the corrected ages of 4, 6, 10, and 12 months and with the Hempel assessment at 18 months. RESULTSThe findings indicated that MND can be assessed reliably (inter-assessor agreement: kappa=0.83). MND during infancy was related to prenatal, perinatal, and social factors, and in particular to preterm birth. Neurological condition during infancy was prone to change, but was related to neurological condition at 18 months at all ages tested. INTERPRETATIONWe conclude that MND can be determined reliably in infancy. Important considerations in the construct of MND in infancy are its relation to prenatal and perinatal factors, its limited stability, and its moderate predictive value.Neurological assessment is one of the clinical tools used to monitor development in infants at risk for developmental disorders, such as infants born preterm. Multiple methods are available, such as the Amiel-Tison neurological examination, 1 the Touwen Infant Neurological Examination (TINE), 2 the Hammersmith Infant Neurological Examination (HINE), 3 and the neurofunctional assessment of Picciolini et al. 4 Little is known about the reliability of these widely used methods. 5 The validity of neurological assessments has been studied to some extent; marked neurological dysfunction during infancy has considerable power to predict developmental disability such as cerebral palsy (CP). [5][6][7] However, knowledge about the significance of signs of minor neurological dysfunction (MND) during infancy is scarce.Our knowledge of MND is based in particular on data of children above preschool age. Two distinct forms of MND have been distinguished: simple and complex MND.8 Before the onset of puberty the distinction is based on the number of dysfunctions present; after the onset of puberty classification is based on the type of dysfunction. Simple MND may be regarded as the expression of a normal but non-optimally functioning nervous system (minor neurological difference). In contrast, complex MND is the form of MND which is strongly related to pre-and perinatal adversities and to learning and behavioural disorders. From an aetiological point of view, this suggests that it may be considered as a borderline form of CP.8 It is uncertain whether the concept of simple ...

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confidence: 99%

The assessment of minor neurological dysfunction in infancy using the Touwen Infant Neurological Examination: strengths and limitations

Hadders‐Algra

Heineman

Bos

et al. 2009

Develop Med Child Neuro

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“…El desarrollo motor temprano como predictor de la condición del niño en etapas posteriores ha sido bien investigado, no sólo como un predictor potente de parálisis cerebral, sino también de otras alteraciones menores en el desarrollo o inclusive de retrasos en la comunicación (Bhat, Galloway & Landa, 2012;Bruggink et al, 2008;de Kieviet, Piek, Aarnoudse-Moens & Oosterlaan, 2009;Kodric, Sustersic & Paro-Panjan, 2010;Sustersic, Sustar & Paro-Panjan, 2012). Los resultados del modelo aplicado al mostrar el valor predictivo de las interacciones madre-hijo en el desarrollo motor de niños con riesgo, tienen implicaciones teó-ricas al considerar que es en los niveles sensoriomotores donde el niño construye sus primeros es quemas cognitivos.…”

Section: Discussionunclassified

Interacciones tempranas madre-niño y predicción de desarrollo motor mediante ecuaciones estructurales: Aplicación del modelo en niños con riesgo de daño neurológico perinatal

Rábago

Ramírez

Pérez

et al. 2013

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RESUMENLos impactos más importantes de las expresiones tempranas del daño neurológico en los niños, son las dificultades para establecer intercambios con su medio social, afectando en la etapa inicial las primeras interacciones con su ma dre. Niños con riesgo biológico muestran grandes dificultades para iniciar interacciones. Cuando las madres se ajustan en una relación bidireccional se logra un aumento en las iniciaciones del niño; si las madres responden menos, los niños disminuyen las iniciaciones y aumentan la irritabilidad.Los programas de intervención temprana que integran en sus estrategias el manejo de las interac ciones madre-niño se han considerado exitosos por sus implicaciones directas en el desa rrollo del niño. Se requiere mayor soporte empírico sobre la influencia de patrones específicos de in teracciones tempranas madre-hijo y el desa rrollo posterior de niños con daño neurológico perinatal, en términos de prevención de alte raciones o discapacidad. Se realizó un estudio longitudinal y se reporta el efecto de las interacciones de reciprocidad madre-hijo en el desa rrollo motor observado en niños a los 4, 8 y 12 meses de edad, a través del empleo del Modelo de Ecuaciones Estructurales (Curva de Crecimiento Latente). Se concluye que el modelo permitió mostrar que en niños de riesgo perinatal, las interacciones madre-hijo representan un buen predictor del desarrollo motor en el primer año de vida. Estos hallazgos tienen importantes impli-

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“…During this period, MOS could range from 5 (low optimality) to 28 (high optimality). Previously, the interrater agreement was reported to be good; the kappa statistics vary from 0.89 to 0.91 (14,15).…”

Section: Analysis Of Gmsmentioning

confidence: 95%

“…The quality of the fidgety general movements (FMs), present between 9 and 20 weeks after term and defined as continuous small movements of moderate speed in all directions, is a particularly accurate marker for neurological outcome: most infants (96%) with normal FMs have normal neurological outcomes, whereas most infants (95%) in whom FMs are absent during this period develop cerebral palsy (13). Recent studies reported that detailed aspects of GMs, expressed as a motor optimality score (MOS), also have predictive value for mild motor abnormalities later on (14,15).…”

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confidence: 99%

Hydrocortisone vs. dexamethasone treatment for bronchopulmonary dysplasia and their effects on general movements in preterm infants

et al. 2011

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INTRODUCTION: hydrocortisone (hc) and dexamethasone (DXM) are used to treat preterm infants at risk for bronchopulmonary dysplasia (BPD). This may, however, affect their longterm neurological development. We aimed to determine the effect of hc and DXM therapy in preterm infants on neurological functioning as assessed by the quality of general movements (GMs) until 3 months after term. RESULTS: We found no difference in the quality of GMs between hc and DXM infants until term age. at 3 months, hc infants had a higher median motor optimality score (MOs) than DXM infants (25 vs. 21, P = 0.015). In the DXM group, MOs on the first day of treatment was lower than before treatment (10 vs. 11, P = 0.030). DISCUSSION: MOs decreased in DXM infants on the first day following treatment and at 3 months after term. This was not the case in hc infants. Our study suggests that neurological functioning at 3 months after term is better in infants treated with hc than in infants treated with DXM. METHODS:We performed a longitudinal, observational study including 56 preterm infants (n = 17 hc, n = 17 DXM, n = 22 controls). GM quality, videoed before and after treatment, was assessed. In addition, a MOs was assigned to details of the GMs.

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The Quality of the Early Motor Repertoire in Preterm Infants Predicts Minor Neurologic Dysfunction at School Age

Cited by 114 publications

References 35 publications

The assessment of minor neurological dysfunction in infancy using the Touwen Infant Neurological Examination: strengths and limitations

The assessment of minor neurological dysfunction in infancy using the Touwen Infant Neurological Examination: strengths and limitations

Interacciones tempranas madre-niño y predicción de desarrollo motor mediante ecuaciones estructurales: Aplicación del modelo en niños con riesgo de daño neurológico perinatal

Hydrocortisone vs. dexamethasone treatment for bronchopulmonary dysplasia and their effects on general movements in preterm infants

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