De Bock Freia, Will Heike, Behrenbeck Ulrike, Jarczok Marc N, Hadders-Algra Mijna, Philippi Heike
Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Ludolf-Krehl Strasse 7-11, 68167 Mannheim, Germany; Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany.
Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany.
Res Dev Disabil. 2017 Mar;62:69-80. doi: 10.1016/j.ridd.2017.01.012. Epub 2017 Jan 20.
General movements (GM) are used in academic settings to predict developmental outcome in infants born preterm. However, little is known about the implementation and predictive value of GM in non-academic settings.
The aim of this study is twofold: To document the implementation of GM assessment (GMA) in a non-academic setting and to assess its predictive value in infants born preterm.
We documented the process of implementing GMA in a non-academic outpatient clinic. In addition, we assessed the predictive value of GMA at 1 and 3 months' corrected age for motor and cognitive development at 2 years in 122 children born <33 weeks' gestation. Outcome at two years was based upon the Bayley Scales of Infant Development-II (mental/psychomotor developmental index (MDI, PDI)) and a neurological examination. The infants' odds of atypical outcome (MDI or PDI ≤70 or diagnosis CP) and the predictive accuracy of abnormal GMA were calculated in a clinical routine scenario, which used all available GM information (primarily at 3 months or at 1 month, when 3 months were not available). In addition, separate analysis was undertaken for the samples of GMA at 1 and 3 months.
Tips to facilitate GMA implementation are described. In our clinical routine scenario, children with definitely abnormal GM were more likely to have an atypical two-year outcome than children with normal GM (OR 13.2 (95% CI 1.56; 112.5); sensitivity 55.6%, specificity 82.1%). Definitely abnormal GM were associated with reduced MDI (-12.0, 95% CI -23.2; -0.87) and identified all children with cerebral palsy (CP) in the sample of GMA at 3 months only.
GMA can be successfully implemented in a non-academic outpatient setting. In our clinical routine scenario, GMA allowed for adequate prediction of neurodevelopment in infants born preterm, thereby allaying concerns about diagnostic accuracy in non-academic settings.
在学术环境中，一般运动（GM）用于预测早产儿的发育结局。然而，对于GM在非学术环境中的实施情况和预测价值知之甚少。
本研究有两个目的：记录GM评估（GMA）在非学术环境中的实施情况，并评估其对早产儿的预测价值。
我们记录了在非学术门诊实施GMA的过程。此外，我们评估了122例孕周小于33周出生的儿童在矫正年龄1个月和3个月时GMA对2岁时运动和认知发育的预测价值。两年后的结局基于贝利婴幼儿发展量表第二版（心理/精神运动发育指数（MDI，PDI））和神经学检查。在临床常规情况下，计算了非典型结局（MDI或PDI≤70或诊断为脑瘫）的婴儿的几率以及异常GMA的预测准确性，该情况使用了所有可用的GM信息（主要在3个月时或1个月时，若没有3个月时的信息）。此外，对1个月和3个月时GMA的样本进行了单独分析。
描述了促进GMA实施的提示。在我们的临床常规情况下，GM绝对异常的儿童比GM正常的儿童更有可能出现非典型的两年结局（比值比13.2（95%可信区间1.56；112.5）；敏感性55.6%，特异性82.1%）。GM绝对异常与MDI降低（-12.0，95%可信区间-23.2；-0.87）相关，并且仅在3个月时GMA的样本中识别出了所有脑瘫（CP）儿童。
GMA可以在非学术门诊环境中成功实施。在我们的临床常规情况下，GMA能够充分预测早产儿的神经发育，从而消除了对非学术环境中诊断准确性的担忧。
