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Brandal M.1, Brubakk A.-M.2,3, Vågen R.T.1, Fjørtoft T.1,2
1Clinics of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, 2Children`s and Women`s Health, Trondheim University of Science and Technology, Department of Laborarotory Medicine, Trondheim, Norway, 3St. Olavs Hospital, Trondheim University Hospital, Department of Pediatrics, Trondheim, Norway
Background: Using drugs and alcohol in pregnancy is a well-documented risk factor for later neurological impairment in the offspring. Consequences may sometimes be obvious already at birth, but more often cognitive impairment evolves later in life. Previous studies have shown that infants born preterm with abnormal motor repertoire in infancy may have increased risk for impaired motor and cognitive outcome. However, whether drug exposed infants have abnormal motor repertoire has never been studied.
Purpose: The aim of this study is to describe the quality of the motor repertoire in 31 infants born at term after having been exposed to cannabis, amphetamines, buprenorphine, methadone and alcohol in various combinations in pregnancy.
Methods: Assessment of Motor Repertoire 3-5 months, which is part of Prechtls General Movement Assessment (GMA), was used. Two paediatric physiotherapists trained and certified in the Prechtls GMA and blinded for the infants clinical history assessed the video recordings. Fidgety movements (FMs) were assessed independently by each observer followed by assessment of the concurrent motor repertoire by the same observers by replaying the videos. In case of disagreements a consensus was reached based on additional evaluations. 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 12.8 (±1.0) weeks post term age of 31 drugs exposed infants born from December 2014 to July 2016 was assessed, 13 (43%) girls and 17 (53%) boys with mean birth weight 3061.0 (±773.6) grams and gestational age 38.6 (±2.3) . Two of the 31 infants had abnormal fidgety movements. The quality of the concurrent motor repertoire (in literature also reported as the quality of the movement character) was normal in 10 (32%) infants and abnormal in 21 infants (68%). Among 29 infants with normal FMs the quality of the concurrent movement repertoire was abnormal in 19 infants (61%) in contrast 20% in 87 normal unexposed infants born at term reported in a recent study1. The prevalence of abnormal motor repertoire was unaffected by the type of drug and alcohol use in pregnancy except for the four infants of chronic addicts who all had abnormal concurrent motor repertoire.
Conclusion(s): The majority of the infants exposed to drugs and alcohol in pregnancy had an abnormal quality of the concurrent motor repertoire at 12 weeks post term age. If this is a transitional phenomenon related to drugs in pregnancy or an indicator of later neurological impairment needs to be clarified in follow up studies.
Implications: It is of great importance to have good methods to reveal neurodevelopmental problems at an early stage to start appropriate intervention. Such methods should make it possible to identify the infants at risk instead of treating all as a group. It is also important to have methods to reassure the parents of low risk for developmental impairment.
1 Fjørtoft, T et al. Eur J Paediatr Neurol. 2016 Mar; 20(2):236-42.
Funding acknowledgements: Clinics of Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
Topic: Paediatrics
Ethics approval: Regional Ethic Committee (REK), Trondheim, Norway. October 6th, 2016 number 2016/1618.
All authors, affiliations and abstracts have been published as submitted.
