Dept. of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Early Hum Dev. 2013 Jul;89(7):467-72. doi: 10.1016/j.earlhumdev.2013.03.014. Epub 2013 Apr 25.
Extremely preterm (EPT) birth is a major risk factor for brain injury and neurodevelopmental impairment. Reliable tools for early prediction of outcome are warranted.
To investigate the predictive value of general movements (GMs) at "fidgety age" for neurological outcome at age 30 months in EPT infants, both in comparison and in combination with structural magnetic resonance imaging (MRI) at term equivalent age (TEA).
Fifty-three infants born <27 weeks of gestation were included prospectively. MRI was performed at TEA and images were evaluated for white and grey matter abnormalities. GMs were assessed at age 3 months corrected ("fidgety age").
Neuromotor outcome was assessed at age 30months corrected. Children were classified as having a normal neurological status, unspecific signs, or cerebral palsy (CP).
Abnormal GMs were a common finding, seen in 32% (17/53) of infants. Of these, six infants (11%) had definitely abnormal GMs. Four infants (8%) had a diagnosis of CP at follow up. Definitely abnormal GMs were significantly associated to CP at 30 months (Fisher's Exact test p=0.03, sensitivity 50%, specificity 92%). Moderate-severe white matter abnormalities on MRI were more strongly associated with CP (Fisher's Exact test p<0.001, sensitivity 100%, specificity 98%) than GMs. Combining GMs with MRI-findings at TEA increased the predictive specificity to 100% (Fisher's Exact test, p=0.005), whereas sensitivity remained unchanged.
The presence of definitely abnormal GMs was predictive of CP: prediction was significantly enhanced when the GMs assessment was combined with findings from MRI obtained at TEA.
极早产儿（EPT）出生是脑损伤和神经发育障碍的主要危险因素。需要可靠的工具来早期预测结局。
研究“不安分年龄”的一般运动（GMs）对 EPT 婴儿 30 个月时神经结局的预测价值，包括与胎龄相等时的结构磁共振成像（MRI）的比较和结合。
前瞻性纳入 53 名出生于<27 周妊娠的婴儿。在胎龄相等时进行 MRI 检查，并评估白质和灰质异常。GMs 在 3 个月校正年龄（“不安分年龄”）进行评估。
在 30 个月校正年龄评估神经运动结局。根据神经发育状况将儿童分为正常神经状态、非特异性表现或脑瘫（CP）。
异常 GMs 是一种常见的发现，见于 53 名婴儿中的 32%（17/53）。其中，6 名婴儿（11%）GMs 明显异常。4 名婴儿（8%）在随访时被诊断为 CP。30 个月时明显异常的 GMs 与 CP 显著相关（Fisher 精确检验 p=0.03，敏感性 50%，特异性 92%）。MRI 上发现中重度白质异常与 CP 的相关性更强（Fisher 精确检验 p<0.001，敏感性 100%，特异性 98%），而 GMs 的敏感性不变。将 GMs 与 TEA 时的 MRI 结果相结合，可将预测特异性提高至 100%（Fisher 精确检验，p=0.005），而敏感性保持不变。
明显异常的 GMs 是 CP 的预测指标：当 GMs 评估与 TEA 获得的 MRI 结果相结合时，预测显著增强。
