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 .

Cerebellar hemorrhage in extremely low birth weight infants: incidence, risk factors, and impact on long-term outcomes.

Improvements in neuroimaging technology and techniques have contributed to the increased recognition of cerebellar hemorrhage (CBH) in the prererm infant. Studies have indicated that the extremely low birth weight (ELBW) infant (< 1,000 g) is at highest risk for this injury. Associated risk factors include a constellation of antenaral, intrapartum, and neonatal factors, with immaturity, fetal distress, and cardiorespiratory instability in the early neonatal course as significant contributors. The long-term impact of CBH for the ELBW infant is not fully understood, but recent reports suggest that, in addition to motor impairments, deficits in cognitive, language, and social-behavioral function are also apparent. This article reviews the current state of knowledge of cerebellar development, risk factors for injury, and long-term developmental consequences of injury. Implications for nursing practice, education, and research are discussed.

Testing the satisfaction and feasibility of a computer-based teaching module in the neonatal intensive care unit.

PURPOSE: To examine the satisfaction with and feasibility of a computer-based teaching module to teach healthcare professionals how to use and apply the Premature Infant Pain Profile (PIPP) to clinical scenarios. SUBJECTS: Sixty-eight healthcare professionals who were employed in the neonatal intensive care unit (NICU) on a full-time or part-time basis and had received an educational session regarding the PIPP. DESIGN AND METHODS: A pilot study using an exploratory descriptive design was used to answer: (1) How satisfied are healthcare professionals with the computer-based teaching module? and (2) What is the feasibility of a computer-based teaching module in the clinical setting? Satisfaction was measured using an investigator-developed 5-point Likert scale. Feasibility was measured in terms of time to complete the module, satisfaction with instructions and ability to navigate through the module, acceptability of the module as a teaching method, and format with the computer-based module. PRINCIPAL RESULTS: Ninety percent of those sampled were very satisfied with the computer-based teaching method. Use of video and audio clips and photographs enhanced the learning process. Healthcare professionals identified the computer-based teaching method as an effective way of learning about the PIPP and thought that it was feasible to use within the clinical setting. CONCLUSIONS: Computer-based teaching is a feasible method for educating NICU healthcare professionals about the PIPP. Additional research is required to examine the effectiveness of this teaching method on relevant patient outcomes such as pain management.