Automated Movement Analysis to Predict Cerebral Palsy in Very Preterm Infants: An Ambispective Cohort Study.

The General Movements Assessment requires extensive training. As an alternative, a novel automated movement analysis was developed and validated in preterm infants. Infants < 31 weeks' gestational age or birthweight ≤ 1500 g evaluated at 3−5 months using the general movements assessment were included in this ambispective cohort study. The C-statistic, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for a predictive model. A total of 252 participants were included. The median gestational age and birthweight were 274/7 weeks (range 256/7−292/7 weeks) and 960 g (range 769−1215 g), respectively. There were 29 cases of cerebral palsy (11.5%) at 18−24 months, the majority of which (n = 22) were from the retrospective cohort. Mean velocity in the vertical direction, median, standard deviation, and minimum quantity of motion constituted the multivariable model used to predict cerebral palsy. Sensitivity, specificity, positive, and negative predictive values were 55%, 80%, 26%, and 93%, respectively. C-statistic indicated good fit (C = 0.74). A cluster of four variables describing quantity of motion and variability of motion was able to predict cerebral palsy with high specificity and negative predictive value. This technology may be useful for screening purposes in very preterm infants; although, the technology likely requires further validation in preterm and high-risk term populations.

The assessment of general movements in term and late-preterm infants diagnosed with neonatal encephalopathy, as a predictive tool of cerebral palsy by 2 years of age-a scoping review.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SYSTEMATIC REVIEW REGISTRATION: Title registration with Joanna Briggs Institute. URL: http://joannabriggswebdev.org/research/registered_titles.aspx .

The general movements assessment in term and late-preterm infants diagnosed with neonatal encephalopathy, as a predictive tool of cerebral palsy by 2 years of age: a scoping review protocol.

BACKGROUND: Prediction of long-term neurodevelopmental outcomes remains an elusive goal for neonatology. Clinical and socioeconomic markers have not proven to be adequately reliable. The limitation in prognostication includes those term and late-preterm infants born with neonatal encephalopathy. The General Movements Assessment tool by Prechtl has demonstrated reliability for identifying infants at risk for neuromotor impairment. This tool is non-invasive and cost-effective. The purpose of this study is to identify the published literature on how this tool applies to the prediction of cerebral palsy in term and late-preterm infants diagnosed with neonatal encephalopathy and so detect the research gaps. METHODS: We will conduct a systematic scoping review for data on sensitivity, specificity, positive, and negative predictive value and describe the strengths and limitations of the results. This review will consider studies that included infants more than or equal to 34 + 0 weeks gestational age, diagnosed with neonatal encephalopathy, with a General Movements Assessment done between birth to six months of life and an assessment for cerebral palsy by at least 2 years of age. Experimental and quasi-experimental study designs including randomized controlled trials, non-randomized controlled trials, before and after studies, interrupted time-series studies and systematic reviews will be considered. Case reports, case series, case control, and cross-sectional studies will be included. Text, opinion papers, and animal studies will not be considered for inclusion in this scoping review as this is a highly specific and medical topic. Studies in the English language only will be considered. Studies published from at least 1970 will be included as this is around the time when the General Movements Assessment was first introduced in neonatology as a potential predictor of neuromotor outcomes. We will search five databases (MEDLINE, Embase, PsychINFO, Scopus, and CINAHL). Two reviewers will conduct all screening and data extraction independently. The articles will be categorized according to key findings and a critical appraisal performed. DISCUSSION: The results of this review will guide future research to improve early identification and timely intervention in infants with neonatal encephalopathy at risk of neuromotor impairment. SYSTEMATIC REVIEW REGISTRATION: Title registration with Joanna Briggs Institute https://joannabriggs.org/ebp/systematic_review_register .

Automated movement analysis to predict motor impairment in preterm infants: a retrospective study.

OBJECTIVE: To apply automated movement analysis to the general movements assessment (GMA) to build a predictive model for motor impairment (MI). STUDY DESIGN: A retrospective cohort study including infants ≤306/7 weeks GA or BW ≤1500 g seen at 3-5 months was conducted. Automated video analysis was used to develop a multivariable model to identify MI, defined as Bayley motor composite score <85 or cerebral palsy (CP). RESULTS: One hundred and fifty two videos were analyzed. Median GA and BW were 275/7 weeks and 955 g, respectively. MI and CP rates were 22% (N = 33) and 14% (N = 22). Minimum, mean, and mean vertical velocity of the infant's silhouette correlated significantly with MI. Sensitivity, specificity, positive and negative predictive values, and accuracy of automated GMA were 79%, 63%, 37%, 91%, and 66%, respectively. C-statistic indicated good fit (C = 0.77). CONCLUSIONS: Automated movement analysis predicts MI in preterm infants. Further refinement of this technology is required for clinical application.

Detection of Atypical and Typical Infant Movements using Computer-based Video Analysis.

The diagnosis of cerebral palsy (CP) is difficult before 2 years of age. The general movements assessment (GMA) is a method for predicting CP from the spontaneous movements of infants in the first months of life. This assessment has shown high accuracy in predicting CP, but its use is limited by a lack of trained clinicians and its subjective nature. An objective and cost-effective alternative is the automatic videobased assessment of infant movements. Retrospective videos with clinical GMA outcomes were evaluated against eligibility criteria for the automatic analysis consisting of a skin model for segmentation and large displacement optical flow (LDOF) for motion tracking. Kinematic features were extracted to classify the movements as typical or atypical using different classification algorithms. Preliminary classification results obtained from the analysis of 127 videos of preterm infants showed up to 92% of accuracy in predicting CP. A computerbased assessment would provide clinicians with an objective tool for early diagnosis of CP, to facilitate early intervention and improve functional outcomes.

Prediction of long-term neurodevelopmental outcome in preterm infants using trajectories of general movement assessments.

OBJECTIVE: To assess the predictive value of trajectories and individual assessment of quality of general movements (AQGM) for identification of neurodevelopmental impairment (NDI) at 18-24 months corrected age (CA) in infants <30 weeks gestational age and/or birth weight <1500 g. METHODS: In this retrospective cohort study, AQGM at 6 weeks and 3 months CA were scored and categorized as normal (N) or abnormal (A). AQGM measures were compared with degree of NDI and Bayley Scales of Infant Development, Third Edition (BSID-III) composite motor and cognitive scores. 'Persistently abnormal' AQGM included both mildly abnormal (MA) and definitely abnormal (DA) assessments. A "modified AQGM" where MA assessments were considered normal variant/transient injury was used to conduct post-hoc analysis. RESULTS: Across 244 cases, persistently abnormal AQGM trajectory predicted the level of NDI (OR 2.5, 95% CI 1.2, 5.1) compared to AQGM trajectory that normalized. However, using the "modified AQGM", persistently DA trajectories were associated with significantly lower BSID-III composite motor and cognitive scores (p < 0.001 and p = 0.039, respectively). CONCLUSION: Categorizing MA assessments as transient injury increased the predictive value of AQGM trajectories and significantly predicted lower cognitive and motor scores at 18-24 months CA.

Birth to breast--a feeding care map for the NICU: helping the extremely low birth weight infant navigate the course.

Breast milk has been shown to contribute significantly to positive neurodevelopmental and medical outcomes in the extremely low birth weight (ELBW) infant population. It is crucial that ELBW infants receive their mother's colostrum as a first feeding, followed by expressed breast milk for as long as possible. Evidence-based literature supports the difficult challenges both mothers and ELBW infants face if they are to succeed at breast pumping and breastfeeding. Influencing factors include the medical fragility of the infant, limited frequency and duration of kangaroo care between mother and infant, lack of an adequate volume of breast milk, as well as inconsistent or incorrect information surrounding the use of breast milk and breastfeeding. A feeding care map as described in this article can help the bedside nurse assist the mother-ELBW infant dyad in optimizing breast milk volumes, laying the groundwork for breastfeeding. Displaying supportive practices and preterm infant developmental milestones, the map categorizes infant, maternal, and dyad feeding issues along a progressive time line from admission to discharge.