Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Impact
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The Prechtl GMA, including the MOS-R, can improve early identification of long-term adverse neurodevelopmental outcomes.
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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.
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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.
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Aberrant FMs in combination with a MOS of <21 is an indicator of an increased risk of future adverse neurodevelopment in children born EPT.
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Acknowledgements
We are grateful to all children and parents who participated in the study. We would also like to thank Christina Eriksson and Ann-Christine Eliasson as well as our research nurse Lena Swartling Schlinzig for their valuable contribution. M.Ö. was supported by Region Stockholm (clinical research appointment), Sällskapet Barnavård and the Promobilia Foundation Sweden. U.Å. was supported by grants from the Swedish Medical Research Council (grant number 2017-03043), the Stockholm County Council and the Karolinska Institutet, the Swedish Order of Freemasons in Stockholm, the Swedish Brain Foundation (grant number, FO2019-0045), and The Philipsson Foundation. The funders played no role in any aspect of the study or paper.
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M.Ö. and U.Å. conceptualized the study. All authors made substantial contributions of analysis and interpretation of data. M.Ö. drafted the initial manuscript, which was then critically reviewed and revised by all authors. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
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C.E. is a co-inventor of the MOS-R and member and certified tutor of the General Movements Trust. The other authors have no conflicts to declare.
Consent statement
The study was approved by The Regional Ethics Committee in Lund and Stockholm (2015/488, 2018/2547). All parents or guardians gave their written consent of participation.
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Örtqvist, M., Einspieler, C. & Ådén, U. Early prediction of neurodevelopmental outcomes at 12 years in children born extremely preterm. Pediatr Res 91, 1522–1529 (2022). https://doi.org/10.1038/s41390-021-01564-w
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DOI: https://doi.org/10.1038/s41390-021-01564-w
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