Abstract
Objective Abnormal general movements (GMs) are predictive of later risk of motor impairments
in preterm infants. The goals of this study are to (1) describe the implementation
of the GM assessment (GMA) in a neonatal intensive care unit (NICU) and (2) investigate
the prevalence and evolution of abnormal GMs in very low birth weight (VLBW) infants.
Study Design Observational study of GMs in VLBW infants (gestational age [GA] <32 weeks and/or
birth weight [BW] <1,500 g) following GMA implementation in a level-IV NICU. All VLBW
infants admitted between November 2017 and April 2019 were eligible for the GMA. Infants
were excluded if they required high-frequency ventilation or if they could not be
unbundled for video acquisition. GMAs were scored weekly by at least 2 GMA-certified
providers.
Results The GMA was performed in 121 VLBW infants with a mean (standard deviation [SD]) GA
of 28.3 (2.6) and BW of 1,113 (400 g). Only 28% of infants had normal GMs on initial
assessment (32.9 ± 2.7 weeks' GA), while 61 and 11% had poor repertoire and cramped-synchronized
GMs, respectively. At NICU discharge (37.6 ± 3.4 weeks corrected GA), 45 and 21% of
infants were classified as having poor repertoire and cramped-synchronized GMs, respectively.
Most infants with cramped-synchronized GMs on initial assessment had persistent abnormal
GMs at discharge. In contrast, only one infant with normal GMs on first assessment
developed cramped-synchronized GMs.
Conclusion Abnormal GMs are common in VLBW infants, including a high prevalence of the more
concerning cramped-synchronized movement pattern. The GMA can be successfully performed
in VLBW infants. The GMA may be helpful in identifying infants at increased risk of
later motor impairments, as well as assisting clinicians, in the stratification of
infants who may benefit from additional brain imaging and/or an intensive hospital-based
interventions.
Key Points
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Abnormal GMs are common in VLBW infants.
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Poor repertoire in the most prevalent pattern observed.
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Infants at risk for abnormal motor outcomes can be identified in the NICU.
Keywords
general movement assessment - very low birth weight infant - preterm infant - neonatal
intensive care unit - implementation
