Early neurologic assessment in preterm-infants: Integration of traditional neurologic examination and observation of general movements

      Abstract

      Objective

      To evaluate the possible additional benefit in terms of prognostic accuracy of an integrated application of a traditional scorable method of neurologic examination and the Prechtl's method of qualitative assessment of general movements (GMs) in a large population of 903 consecutive preterm infants.

      Study design

      Infants were enrolled from the Intensive Care Unit of the University of Catania. Inclusion criteria were a gestational age below 37 weeks and the absence of genetic disorders. All infants underwent serial ultrasound and at 3 months performed both the GMs assessment and the Hammersmith Infant Neurologic Examination (HINE). Outcome was assessed at 2 years by the Touwen neurologic examination and the Clinical Adaptive Test/Clinical, Linguistic and Auditory Milestone Scale.

      Results

      The integration of the two methods was shown to be more effective than the single assessments in predicting neurologic outcome. The additional benefit of combining the two approaches was particularly clear for the discrimination between unilateral and bilateral cerebral palsy.

      Conclusions

      The integrated use of a scorable neurological examination and Prechtl's assessment of GMs can improve early prediction of neurodevelopmental outcome in preterm infants and should complement other clinical and instrumental exams in follow-up programs.

      Keywords

      Abbreviations:

      GMs (), general movements (), HINE (), Hammersmith Infant Neurologic Examination (), CP (), cerebral palsy (), MD (), mild disability (), CAT/CLAMS (), Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (), PTA (), post-term age (), FMs (), fidgety movements (), US (), ultrasounds ()
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      References

        • Alexander G.R.
        • Kogan M.
        • Bader D.
        • Carlo W.
        • Allen M.
        • Mor J.
        US birth weight/gestational age-specific neonatal mortality: 1995-1997 rates for whites, hispanics, and blacks.
        Pediatrics. 2003; 111: e61-e66
        • Hoyert D.L.
        • Mathews T.J.
        • Menacker F.
        • Strobino D.M.
        • Guyer B.
        Annual summary of vital statistics: 2004.
        Pediatrics. 2006; 117: 168-183
        • McCormick M.C.
        The contribution of low birth weight to infant mortality and childhood morbidity.
        N Engl J Med. 1985; 312: 82-90
        • Palmer F.B.
        Strategies for the early diagnosis of cerebral palsy.
        J Pediatr. 2004; 145: S8-S11
        • Dubowitz L.M.
        • Dubowitz V.
        • Palmer P.G.
        • Miller G.
        • Fawer C.L.
        • Levene M.I.
        Correlation of neurologic assessment in the preterm newborn infant with outcome at 1 year.
        J Pediatr. 1984; 105: 452-456
        • Ford L.M.
        • Steichen J.
        • Steichen Asch P.A.
        • Babcock D.
        • Fogelson M.H.
        Neurologic status and intracranial hemorrhage in very-low-birth-weight preterm infants.
        Outcome at 1 year and 5 years. Am J Dis Child. 1989; 143: 1186-1190
        • Maas Y.G.
        • Mirmiran M.
        • Hart A.A.
        • Koppe J.G.
        • Ariagno R.L.
        • Spekreijse H.
        Predictive value of neonatal neurological tests for developmental outcome of preterm infants.
        J Pediatr. 2000; 137: 100-106
        • Molteno C.
        • Grosz P.
        • Wallace P.
        • Jones M.
        Neurological examination of the preterm and full-term infant at risk for developmental disabilities using the Dubowitz Neurological Assessment.
        Early Hum Dev. 1995; 41: 167-176
        • Stewart A.
        • Hope P.L.
        • Hamilton P.
        • Costello A.M.
        • Baudin J.
        • Bradford B.
        • et al.
        Prediction in very preterm infants of satisfactory neurodevelopmental progress at 12 months.
        Dev Med Child Neurol. 1988; 30: 53-63
        • Ohgi S.
        • Arisawa K.
        • Takahashi T.
        • Kusumoto T.
        • Goto Y.
        • Akiyama T.
        • et al.
        Neonatal behavioral assessment scale as a predictor of later developmental disabilities of low birth-weight and/or premature infants.
        Brain Dev. 2003; 25: 313-321
        • Ellenberg J.H.
        • Nelson K.B.
        Early recognition of infants at high risk for cerebral palsy: examination at age four months.
        Dev Med Child Neurol. 1981; 23: 705-716
        • N elson K.B.
        • Ellenberg J.H.
        Neonatal signs as predictors of cerebral palsy.
        Pediatrics. 1979; 64: 225-232
        • Einspieler C.
        • Prechtl H.F.R.
        • Bos A.F.
        • Ferrari F.
        • Cioni G.
        Prechtl's method on the qualitative assessment of general movements in preterm, term and young infants.
        Mac Keith Press, London2004
        • Prechtl H.F.
        • Einspieler C.
        • Cioni G.
        • Bos A.F.
        • Ferrari F.
        • Sontheimer D.
        An early marker for neurological deficits after perinatal brain lesions.
        Lancet. 1997; 349: 1361-1363
        • Cioni G.
        • Ferrari F.
        • Einspieler C.
        • Paolicelli P.B.
        • Barbani M.T.
        • Prechtl H.F.
        Comparison between observation of spontaneous movements and neurologic examination in preterm infants.
        J Pediatr. 1997; 130: 704-711
        • Paro-Panjan D.
        • Sustersic B.
        • Neubauer D.
        Comparison of two methods of neurologic assessment in infants.
        Pediatr Neurol. 2005; 33: 317-324
        • Ferrari F.
        • Cioni G.
        • Einspieler C.
        • Roversi M.F.
        • Bos A.F.
        • Paolicelli P.B.
        • et al.
        Cramped synchronized general movements in preterm infants as an early marker for cerebral palsy.
        Arch Pediatr Adolesc Med. 2002; 156: 460-467
      1. National Advisory Board on Medical Rehabilitation Research. Report and plan for medical rehabilitation research, National Center for Rehabilitation Research, Bethesda; 1993.

        • Hadders-Algra M.
        • Mavinkurve-Groothuis A.M.
        • Groen S.E.
        • Stremmelaar E.F.
        • Martijn A.
        • Butcher P.R.
        Quality of general movements and the development of minor neurological dysfunction at toddler and school age.
        Clin Rehabil. 2004; 18: 287-299
      2. Amiel-Tison C. Clinical assessment of the infant nervous system. In: Levene MI, Lilleford RJ, Bennett MJ, Punt J, editors. Fetal and neonatal neurology and neurosurgery, 2nd ed. Edinburgh: Churchill Livngstone; 1995. p. 83–104.

        • Haataja L.
        • Mercuri E.
        • Regev R.
        • Cowan F.
        • Rutherford M.
        • Dubowitz V.
        • et al.
        Optimality score for the neurologic examination of the infant at 12 and 18 months of age.
        J Pediatr. 1999; 135: 153-161
        • Touwen B.C.L.
        Neurological development in infancy.
        Mac Keith Press, London1976
        • Hoon Jr., A.H.
        • Pulsifer M.B.
        • Gopalan R.
        • Palmer F.B.
        • Capute A.J.
        Clinical adaptive test/clinical linguistic auditory milestone scale in early cognitive assessment.
        J Pediatr. 1993; 123: S1-S8
        • Haataja L.
        • Cowan F.
        • Mercuri E.
        • Bassi L.
        • Guzzetta A.
        • Dubowitz L.
        Application of a scorable neurologic examination in healthy term infants aged 3–8 months.
        J Pediatr. 2003; 143: 546
      3. Bayley N. Bayley scales of infant development-II. San Antonio, TX; 1993.

        • Kube D.A.
        • Wilson W.M.
        • Petersen M.C.
        • Palmer F.B.
        CAT/CLAMS: its use in detecting early childhood cognitive impairment.
        Pediatr Neurol. 2000; 23: 208-215
        • Hagberg G.
        • Hagberg G.
        • Olow I.
        The changing panorama of cerebral palsy in Sweden 1954–1970. II. Analysis of the various syndromes.
        Acta Paediatr Scand. 1975; 64: 193-200
      4. Volpe JJ. Neurology of the newborn, 4th ed. USA; 2001.

        • Cohen J.
        A coefficient of agreement for nominal scales.
        Educ Psychol Meas. 1960; 20: 37-46
        • Frisone M.F.
        • Mercuri E.
        • Laroche S.
        • Foglia C.
        • Maalouf E.F.
        • Haataja L.
        • et al.
        Prognostic value of the neurologic optimality score at 9 and 18 months in preterm infants born before 31 weeks’ gestation.
        J Pediatr. 2002; 140: 57-60
        • Haataja L.
        • Mercuri E.
        • Guzzetta A.
        • Rutherford M.
        • Counsell S.
        • Flavia Frisone M.
        • et al.
        Neurologic examination in infants with hypoxic-ischemic encephalopathy at age 9–14 months: use of optimality scores and correlation with magnetic resonance imaging findings.
        J Pediatr. 2001; 138: 332-337
        • Ricci D.
        • Cowan F.
        • Pane M.
        • Gallini F.
        • Haataja L.
        • Luciano R.
        • et al.
        Neurological examination at 6 to 9 months in infants with cystic periventricular leukomalacia.
        Neuropediatrics. 2006; 37: 247-252
      5. Abram H. Vascular Disease. In: RB D, editor. Child and adolescent neurology. St. Louis: Mosby; 1998. p. 271–93.

        • Bouza H.
        • Rutherford M.
        • Acolet D.
        • Pennock J.M.
        • Dubowitz L.M.
        Evolution of early hemiplegic signs in full-term infants with unilateral brain lesions in the neonatal period: a prospective study.
        Neuropediatrics. 1994; 25: 201-207
        • Bos A.F.
        • Einspieler C.
        • Prechtl H.F.R.
        • Touwen B.M.O.-B.
        • Stremmelar F.
        The quality of spontaneous motor activity in preterm infants as early predictive signs for minor neurological abnormalities at two years.
        Newsl Neonat Neurol. 1999; 8: 4-5
      6. Einspieler C, Marschik PB, Milioti S, Nakajima Y, Bos AF, Prechtl HF. Are abnormal fidgety movements an early marker for complex minor neurological dysfunction at puberty? Early Hum Dev 2006.

        • Lunsing R.J.
        • Hadders-Algra M.
        • Huisjes H.J.
        • Touwen B.C.
        Minor neurological dysfunction from birth to 12 years.
        I: Increase during late school-age. Dev Med Child Neurol. 1992; 34: 399-403