Crowle Cathryn, Loughran Fowlds Alison, Novak Iona, Badawi Nadia
The Children's Hospital Westmead, Sydney 2145, Australia.
Faculty of Medicine, The University of Sydney, Sydney 2050, Australia.
J Clin Med. 2019 Aug 22;8(9):1286. doi: 10.3390/jcm8091286.
The general movements (GMs) assessment is recognised as one of the most important tools in the early detection of cerebral palsy (CP). However, there remains a paucity of data on its application to infants with congenital anomalies requiring surgery. This was a prospective study of 202 infants (mean gestation 38 weeks, SD 2.2) who had undergone major surgery for congenital anomalies in the neonatal period. Infants were assessed at three months of age (mean 12 weeks, SD 1.6) and GMs videos were independently rated by three clinicians, two blinded to clinical details. Developmental follow-up was at three years of age. Of the twenty-five infants (9%) rated as having an absence of fidgety movements, 22 were seen at 3 years, and 17 had an abnormal outcome: 11 with CP, and 6 with a developmental disability. Infants with absent fidgety movements were 21.5 (95% CI 7.3-63.8) times more likely to have an abnormal outcome including CP. None of the infants with normal fidgety movements had a diagnosis of CP and 86% were assessed to be developing normally. The GMs assessment has predictive value for cerebral palsy and neurodevelopment for infants with congenital anomalies, and should be incorporated into routine follow-up to facilitate early referral.
全身运动（GMs）评估被认为是早期发现脑瘫（CP）的最重要工具之一。然而，关于其应用于需要手术的先天性异常婴儿的数据仍然很少。这是一项对202名婴儿（平均孕周38周，标准差2.2）进行的前瞻性研究，这些婴儿在新生儿期因先天性异常接受了大手术。在婴儿三个月大时（平均12周，标准差1.6）进行评估，GMs视频由三名临床医生独立评分，其中两名对临床细节不知情。发育随访在三岁时进行。在被评为无不安运动的25名婴儿（9%）中，22名在3岁时接受了检查，17名结果异常：11名患有脑瘫，6名有发育障碍。无不安运动的婴儿出现包括脑瘫在内的异常结果的可能性高21.5倍（95%可信区间7.3 - 63.8）。所有不安运动正常的婴儿均未被诊断为脑瘫，86%被评估为发育正常。GMs评估对先天性异常婴儿的脑瘫和神经发育具有预测价值，应纳入常规随访以促进早期转诊。
