Beatrix Children's Hospital - Developmental Neurology, University Medical Centre Groningen, 9713 GZ Groningen, the Netherlands.
Dev Med Child Neurol. 2010 May;52(5):456-61. doi: 10.1111/j.1469-8749.2009.03529.x. Epub 2009 Nov 30.
Definitely abnormal general movements in populations of high-risk infants predict serious neurodevelopmental impairment. This study aimed to assess predictive values of definitely abnormal general movements at 3 months for serious neurodevelopmental impairment in a representative sample of the general population.
A prospective cohort study of 455 3-month-old infants was performed (241 females, 214 males; mean birthweight 3452g, SD 604g; mean gestational age 39.4wks, SD 1.96; n=32 born preterm). At enrolment, general movement quality was assessed by means of video recording. At 4 years, all participants were reassessed by well-baby health clinicians; if serious neurodevelopmental impairment was identified, clinical records were reviewed. Predictive values of definitely abnormal general movement quality for major neurodevelopmental impairment were calculated.
Five children were diagnosed as having a major neurodevelopmental disorder with serious implications for daily life, including three children with cerebral palsy (CP). Three out of the five had shown definitely abnormal general movements; they had lesions involving the periventricular white matter. Two children did not show definitely abnormal general movements; one had unilateral spastic CP due to a cortical lesion and the other had ataxia due to cerebellar atrophy. The positive predictive value of definitely abnormal general movements for major neurodevelopmental impairment was 18/100, and for CP it was 12/100. Negative predictive values approached 100%.
The good predictive value of general movement assessment in high-risk populations cannot be generalized to the general population.
高危婴儿群体中明显异常的一般运动确实可预测严重的神经发育障碍。本研究旨在评估 3 月龄时明显异常的一般运动对一般人群代表性样本中严重神经发育障碍的预测价值。
对 455 名 3 月龄婴儿进行了前瞻性队列研究（241 名女性，214 名男性；平均出生体重 3452g，标准差 604g；平均胎龄 39.4 周，标准差 1.96；32 名早产儿出生）。在入组时，通过录像评估一般运动质量。在 4 岁时，所有参与者均由婴幼儿健康临床医生重新评估；如果发现严重神经发育障碍，则对临床记录进行审查。计算明显异常的一般运动质量对主要神经发育障碍的预测值。
5 名儿童被诊断为患有严重影响日常生活的主要神经发育障碍，包括 3 名脑瘫（CP）儿童。其中 3 名儿童出现明显异常的一般运动，他们的病变累及脑室周围白质。2 名儿童未出现明显异常的一般运动，1 名儿童因皮质病变导致单侧痉挛性 CP，另 1 名儿童因小脑萎缩导致共济失调。明显异常的一般运动对主要神经发育障碍的阳性预测值为 18/100，对 CP 的阳性预测值为 12/100。阴性预测值接近 100%。
高危人群中一般运动评估的良好预测价值不能推广到一般人群。
