Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Toronto, Toronto, Canada.
Syst Rev. 2021 Aug 12;10(1):226. doi: 10.1186/s13643-021-01765-8.
The General Movements Assessment is a non-invasive and cost-effective tool with demonstrated reliability for identifying infants at risk for cerebral palsy. Early detection of cerebral palsy allows for the implementation of early intervention and is associated with better functional outcomes. No review to date has summarized the utility of the General Movements Assessment to predict cerebral palsy in term and late-preterm infants diagnosed with neonatal encephalopathy.
We conducted a scoping review involving infants born greater than or equal to 34 weeks gestational age to identify all available evidence and delineate research gaps. We extracted data on sensitivity, specificity, and positive and negative predictive values and described the strengths and limitations of the results. We searched five databases (MEDLINE, Embase, PsychINFO, Scopus, and CINAHL) and the General Movements Trust website. Two reviewers conducted all screening and data extraction independently. The articles were categorized according to key findings, and a critical appraisal was performed.
Only three studies, a cohort and two case series, met all of the inclusion criteria. The total number of participants was 118. None of the final eligible studies included late-preterm neonates. All three studies reported on sensitivity, specificity, and positive predictive and negative predictive values. An abnormal General Movement Assessment at 3-5 months has a high specificity (84.6-98%) for cerebral palsy with a similarly high negative predictive value (84.6-98%) when it was normal. Absent fidgety movements, in particular, are highly specific (96%) for moderate to severe cerebral palsy and carry a high negative predictive value (98%) when normal. In the time period between term and 4-5 months post-term, any cramped synchronized movements had results of 100% sensitivity and variable results for specificity, positive predictive value, and negative predictive value.
A normal General Movements Assessment at 3 months in a term high-risk infant is likely associated with a low risk for moderate/severe cerebral palsy. The finding of cramped synchronized General Movements is a strong predictor for the diagnosis of cerebral palsy by 2 years of age in the term population with neonatal encephalopathy. The deficit of high-quality research limits the applicability, and so the General Movements Assessment should not be used in isolation when assessing this population.
Title registration with Joanna Briggs Institute. URL: http://joannabriggswebdev.org/research/registered_titles.aspx .
全身运动评估是一种非侵入性且具有成本效益的工具，已被证明在识别脑瘫高危婴儿方面具有可靠性。早期发现脑瘫可以进行早期干预，并与更好的功能结果相关。迄今为止，尚无综述总结全身运动评估在足月和晚期早产儿中预测新生儿脑病后脑瘫的效用。
我们进行了范围综述，纳入了大于或等于 34 周胎龄的婴儿，以确定所有可用证据并确定研究空白。我们提取了敏感性、特异性、阳性和阴性预测值的数据，并描述了结果的优势和局限性。我们检索了五个数据库（MEDLINE、Embase、PsychINFO、Scopus 和 CINAHL）和全身运动信托网站。两位评审员独立进行了所有的筛选和数据提取。根据关键发现对文章进行分类，并进行了批判性评估。
仅有三项研究，一项队列研究和两项病例系列研究，符合所有纳入标准。参与者总数为 118 人。最终符合条件的研究中均无晚期早产儿。所有三项研究均报告了敏感性、特异性、阳性和阴性预测值。3-5 个月时异常的全身运动评估对脑瘫具有高特异性（84.6-98%），当正常时，阴性预测值也同样较高（84.6-98%）。特别是，缺乏烦躁不安的运动对中重度脑瘫具有高度特异性（96%），当正常时，阴性预测值也很高（98%）。在从足月到 4-5 个月的这段时间内，任何痉挛性同步运动的敏感性均为 100%，特异性、阳性预测值和阴性预测值的结果各不相同。
足月高危婴儿在 3 个月时正常的全身运动评估可能与中重度脑瘫的低风险相关。在新生儿脑病的足月人群中，发现僵硬同步的全身运动是 2 岁时脑瘫诊断的有力预测指标。高质量研究的缺乏限制了其适用性，因此在评估该人群时，不应单独使用全身运动评估。
标题在 Joanna Briggs 研究所注册。网址：http://joannabriggswebdev.org/research/registered_titles.aspx。
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