Very low birth weight infants in China: the predictive value of the motor repertoire at 3 to 5months for the motor performance at 12months

Abstract

BackgroundStudies on motor performance and its early markers are rare in China, especially in very low birth weight (VLBW) infants.ObjectiveApart from the assessment of the inter-scorer agreement, we aimed to analyze to what extent the motor repertoire at 10 to 18 weeks postterm was related to neonatal complications, and gross and fine motor performance at 12 months after term.Study designExploratory prospective study.SubjectsSeventy-four VLBW infants (58 males; mean gestational age = 29 weeks; mean birth weight = 1252 g).MethodFive-minute video recordings were performed at 10 to 18 weeks after term; fidgety movements and the concurrent motor patterns (resulting in a motor optimality score) were assessed according to the Prechtl general movements assessment (GMA). The gross and fine motor performance was assessed by means of the Peabody Developmental Motor Scales, second edition, at 12 months.ResultsReliability was excellent. Pneumonia was associated with absent fidgety movements; the motor optimality score was lower in infants with pneumonia and/or bronchopulmonary dysplasia. Both absent fidgety movements and a lower motor optimality score were associated with a poor or very poor gross and fine motor performance at the 12-month-assessment.ConclusionBoth the assessment of fidgety movements and the evaluation of the concurrent motor repertoire contribute significantly to an identification of VLBW children with a poor gross and fine motor outcome at 12 months. The results of this study document the need for an early identification of infants at high risk for a poor motor performance.

The general movement assessment in non-European low- and middle-income countries

“…Another study on VLBW infants and their GM was recently conducted in India, applying both visual perception-based and computer-based GMA 2 . Similar to Zang et al 51 , the Indian study showed that absent or abnormal FM and a monotonously abnormal movement character was associated with lower motor quotients at 12 months corrected age. The computer-based GMA confirmed that the variability of the spatial center of motion was higher – thus indicating absent FM – in children with lower motor quotients 2 .…”

“…In Asia, three Chinese studies 32 , 49 , 51 , one study conducted in India 2 , and one Iranian study 45 met the inclusion criteria. Yang et al 49 conducted a longitudinal assessment in a large number of children, confirming that the absence of FM was a significant marker of CP.…”

“…Although more than 100,000 infants with very low birth weight are born annually in China 31 , studies on their early motor performance are still scarce. Recently, Zang et al 51 demonstrated that both absent FM and a low MOS were associated with a poor or even very poor gross and fine motor performance at 12 months corrected age. Such an early identification enables early intervention programmes before pathological features become manifest.…”

Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

“…The motor repertoire of infants at 3–5 months consists not only of fidgety movements but also of other movements such as antigravity movements to the midline and legs lift, kicking, swiping, or wiggling-oscillating limb movements [13]. A detailed assessment of these age-specific movements including fidgety movements and several postural patterns was proposed in 2004 [5] and has been applied to several high-risk groups (e.g., [6,14,15,16]) but also to typically developing infants [6,17,18]. The scoring is based on the optimality concept [19], with the advantage that its semi-quantitative approach documents small changes in an otherwise categorically assessed motor behavior.…”

“…The scoring is based on the optimality concept [19], with the advantage that its semi-quantitative approach documents small changes in an otherwise categorically assessed motor behavior. Some of the studies applying this approach revealed that a reduced score was associated with motor and language dysfunction at toddler age [6,15], minor neurological dysfunctions [20], or learning difficulties at school age [21]. Two other studies [22,23] showed that such a detailed assessment of early movements and postures helps to predict the level of self-mobility in children with CP.…”