ABNORMAL MOTOR REPERTOIRE AT THREE MONTHS CORRECTED AGE IS COMMON IN INFANTS BORN PRETERM

Fjørtoft T.1,2, Ustad T.1,2, Jørgensen L.3,4, Kaaresen P.I.5, Øberg G.K.3,4
1Clinics of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, 2NTNU, Norwegian University of Science and Technology, Trondheim, Norway, 3University of Tromsø, The Arctic University of Norway, Department of Health and Care Sciences, Tromsø, Norway, 4University Hospital North Norway, Section of Physiotherapy, Tromsø, Norway, 5University Hospital North Norway, Pediatric and Adolescent Department, Tromsø, Norway

Background: The motor repertoire of infants 3-5 months post- term age comprises fidgety movements (FMs), which characterize general movements, and movements co-occurring with the FMs, the concurrent motor repertoire. Previous studies have shown that infants born preterm with abnormal motor repertoire in infancy may have increased risk of impaired motor and cognitive outcome.

Purpose: The aim of this study is to describe the quality of the motor repertoire in a non-selected group of infants born at gestational age 32 weeks.

Methods: “Assessment of Motor Repertoire 3-5 months”, which is part of Prechtl’s “General Movement Assessment” (GMA), was used. Three paediatric physiotherapists trained and certified in the Prechtl’s GMA and blinded for the infants’ clinical history assessed the video recordings. The FMs were assessed independently by each observer followed by assessment of the concurrent motor repertoire by replaying the videos. In case of disagreements, consensus was reached based on additional evaluations. The FMs were classified as normal if present and abnormal if absent, sporadic or exaggerated. The quality of the concurrent motor repertoire was classified as normal if smooth and fluent and abnormal if monotonous, stiff, jerky and/or predominately with fast or slow speed.

Results: Video recordings at mean 12.1 (±1.0) weeks post term age of 130 infants from three hospitals in Norway, 63 girls and 67 boys, with mean birth weight 1384.8 (±384.5) grams and gestational age 29.7 (±2.2), were included. Twenty-two (17%) out of the 130 infants had abnormal fidgety movements (5 with absence of FMs, 17 with sporadic FMs and none with exaggerated FMs). Sixty-three (48 %) out of 130 infants had normal concurrent motor repertoire, and 67 (52%) infants presented abnormal concurrent motor repertoire. Among the 108 infants with normal FMs 46 (43%) had abnormal quality of the concurrent movement repertoire. These results are in contrast to a previous study of 87 healthy term-born where the prevalence of abnormal concurrent motor repertoire was reported to be approximately 20%¹.

Conclusion(s): In this study we have demonstrated that as many as half of the preterm born infants present abnormal concurrent motor repertoire at 12 weeks post- term age. The fact that abnormal concurrent motor repertoire is seen so frequently in infants born preterm indicate that for some infants this abnormality is a transitional phenomenon related to prematurity itself and for others an indicator of later neurological impairment. Distinguishing between these two groups of infants is a challenge for future research.

Implications: The results of this study suggest that abnormal concurrent motor repertoire is frequent in infants born preterm. Since the number of survivors of infants born preterm is increasing, it is important to have diagnostic tools with high enough sensitivity and specificity with respect to future needs. Just as important is to be able to reassure parents as early as possible that their children will develop normally and not suffer longstanding problems caused by their prematurity. Studies of general movements and the concurrent motor repertoire in infancy could contribute to meet these challenges. 1 Fjørtoft, T et al. Eur J Paediatr Neurol. 2016 Mar;20(2):236-42.

Funding acknowledgements: St. Olavs Hospital, Trondheim University Hospital, Norway and the Norwegian Fund for Post-Graduate Training in Physiotherapy.

Topic: Paediatrics

Ethics approval: Approved by the Regional Committee for Medical and Health Research Ethics North in Norway; Norway (REC North: 2009/916-7).


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