Örtqvist Maria, Einspieler Christa, Ådén Ulrika
Neonatal Research Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
Research Unit Interdisciplinary Developmental Neuroscience, Dept. Phoniatrics, Medical University of Graz, Graz, Austria.
Pediatr Res. 2022 May;91(6):1522-1529. doi: 10.1038/s41390-021-01564-w. Epub 2021 May 10.
Extremely preterm (EPT) birth is a major risk factor for neurodevelopmental impairments. The aim was to evaluate the predictive value of Prechtl General Movement Assessment (GMA), including the Motor Optimality Score-Revised (MOS-R), at 3 months corrected age (CA) for adverse neurodevelopmental outcome at the age of 12 years.
The GMA, including the MOS-R, was applied at 3 months CA and outcomes were assessed at 12 years by Touwen's neurological examination, the Movement Assessment Battery for Children-2, and chart reviews.
Fifty-three infants born EPT (33 boys, mean GA 25 weeks, mean body weight 805 ± 156 g) were included. Forty-two (79%) children participated in the follow-up (mean age 12.3 ± 0.4) and 62% of these had adverse outcomes. The MOS-R differed between groups (p = 0.007). The respective predictive values of GMA, aberrant FMs, and the MOS-R cut-off of 21 for adverse outcomes were positive predictive values (PPVs) of 1.00 and 0.77, negative predictive value of 0.47 and 0.63, sensitivity of 0.31 and 0.77, and specificity of 1.00 and 0.77.
Using the Prechtl GMA, including the MOS-R, at 3 months CA predicted an overall adverse neurodevelopment at 12 years, with a high PPV, specificity, and sensitivity in children born EPT.
The Prechtl GMA, including the MOS-R, can improve early identification of long-term adverse neurodevelopmental outcomes. This is the first study to investigate the predictive value of the MOS-R for neurodevelopmental outcome at mid-school age in children born EPT. Using the GMA, including the MOS-R, is suggested as one important part of the neurological assessment at 3 months CA in children born EPT. Aberrant FMs in combination with a MOS of <21 is an indicator of an increased risk of future adverse neurodevelopment in children born EPT.
极早产儿（EPT）出生是神经发育障碍的主要危险因素。目的是评估在矫正年龄（CA）3个月时Prechtl全身运动评估（GMA），包括修订后的运动最优性评分（MOS-R），对12岁时不良神经发育结局的预测价值。
在CA 3个月时应用GMA，包括MOS-R，并在12岁时通过Touwen神经学检查、儿童运动评估量表-2以及病历回顾来评估结局。
纳入了53例EPT出生的婴儿（33例男孩，平均孕龄25周，平均体重805±156 g）。42例（79%）儿童参与了随访（平均年龄12.3±0.4岁），其中62%有不良结局。两组间MOS-R存在差异（p = 0.007）。GMA、异常运动模式（FMs）以及MOS-R临界值为21时对不良结局的各自预测价值为：阳性预测值（PPV）分别为1.00和0.77，阴性预测值为0.47和0.63，敏感性为0.31和0.77，特异性为1.00和0.77。
在CA 3个月时使用Prechtl GMA，包括MOS-R，可预测12岁时的总体不良神经发育情况，对EPT出生的儿童具有较高的PPV、特异性和敏感性。
Prechtl GMA，包括MOS-R，可改善对长期不良神经发育结局的早期识别。这是第一项研究MOS-R对EPT出生儿童中学年龄时神经发育结局预测价值的研究。建议在EPT出生儿童CA 3个月时，将使用GMA，包括MOS-R，作为神经学评估的一个重要部分。异常FMs与MOS<21相结合是EPT出生儿童未来发生不良神经发育风险增加的一个指标。
