Pires C1, Marba S1, Caldas J1, Turolla de Souza R1
1Universidade Estadual de Campinas, Campinas, Brazil
Background: Early detection of neurodevelopment impairment is essential for planning interventions to promote proper development of the preterm infants. The General Movements Assessment is performed in order to determine the integrity of the central nervous system and is indicated for fragile neonates because it consists of a quick, non-invasive and no-handling method, which is based on the qualitative evaluation of spontaneous movements of the patient. The comparison of this method with the classic neurological evaluation and brain ultrasound showed a greater predictive value of the method in the evaluation of neurological late performance.
Purpose: To discuss the predictive value of General Movements Assessment for the diagnosis of neurodevelopment disorders in preterm newborns.
Methods: Primary, a systematic review of the literature was made using the data bases: BIREME, SCIELO and PUBMED. The articles were filtered by language, year of publication, population of interest, the use of Prechtl´s Method on the Qualitative Assessment of General Movements and presence of variables related to the predictive value. Quality Assessment of Diagnostic Accuracy Studies II was used to assess the methodology of the included studies. The meta-analysis to estimate the proportion of the confidence interval and accuracy of General Movements Assessment was performed considering the random model.
Results: Six from 237 articles were included. The quality assessment show 83,33% high risk of bias in patient selection and 16,66% high risk of bias in flow and timing. The statistic indicates significant heterogeneity between all studies (p .0001). For cerebral palsy as outcome for writhing period, the results suggested a good sensitivity and negative predictive value (100%) with low values of specificity (51%) and positive predictive value (18%). For minor neurological dysfunctions as outcome for writhing period, the results suggested a good sensitivity (86%) and negative predictive value (83%) with low values of specificity (38%) and positive predictive value (33%). For cerebral palsy as outcome for fidgety period the results suggest good sensitivity (100%), specificity (88%) and negative predictive value (100%) with positive predictive value of 60%. For minor neurological dysfunctions. as outcome for fidgety period, the results suggested low sensitivity (66%), specificity (64%), positive predictive value (34%) and negative predictive value of 90%. Therefore, the scale has great potential in the detection of individuals who evolve to neurodevelopment disorders, mainly in relation to cerebral palsy.
Conclusion(s): Despite the high predictive values, the publication of new studies is necessary with adequacy of subjects selection and standardization of assessment scales in the long term, so that the predictive value of the scale can be extrapolated to the general population of preterm newborns.
Implications: The use of General Movements Assessment during the first months of life can help to identify high risk babies that need to be referred to a follow up program.
Keywords: Neurologic examination, premature infant, prognosis
Funding acknowledgements: The author(s) received no financial support for the research, authorship or publication of this article.
Purpose: To discuss the predictive value of General Movements Assessment for the diagnosis of neurodevelopment disorders in preterm newborns.
Methods: Primary, a systematic review of the literature was made using the data bases: BIREME, SCIELO and PUBMED. The articles were filtered by language, year of publication, population of interest, the use of Prechtl´s Method on the Qualitative Assessment of General Movements and presence of variables related to the predictive value. Quality Assessment of Diagnostic Accuracy Studies II was used to assess the methodology of the included studies. The meta-analysis to estimate the proportion of the confidence interval and accuracy of General Movements Assessment was performed considering the random model.
Results: Six from 237 articles were included. The quality assessment show 83,33% high risk of bias in patient selection and 16,66% high risk of bias in flow and timing. The statistic indicates significant heterogeneity between all studies (p .0001). For cerebral palsy as outcome for writhing period, the results suggested a good sensitivity and negative predictive value (100%) with low values of specificity (51%) and positive predictive value (18%). For minor neurological dysfunctions as outcome for writhing period, the results suggested a good sensitivity (86%) and negative predictive value (83%) with low values of specificity (38%) and positive predictive value (33%). For cerebral palsy as outcome for fidgety period the results suggest good sensitivity (100%), specificity (88%) and negative predictive value (100%) with positive predictive value of 60%. For minor neurological dysfunctions. as outcome for fidgety period, the results suggested low sensitivity (66%), specificity (64%), positive predictive value (34%) and negative predictive value of 90%. Therefore, the scale has great potential in the detection of individuals who evolve to neurodevelopment disorders, mainly in relation to cerebral palsy.
Conclusion(s): Despite the high predictive values, the publication of new studies is necessary with adequacy of subjects selection and standardization of assessment scales in the long term, so that the predictive value of the scale can be extrapolated to the general population of preterm newborns.
Implications: The use of General Movements Assessment during the first months of life can help to identify high risk babies that need to be referred to a follow up program.
Keywords: Neurologic examination, premature infant, prognosis
Funding acknowledgements: The author(s) received no financial support for the research, authorship or publication of this article.
Topic: Paediatrics; Neurology; Critical care
Ethics approval required: No
Institution: Universidade Estadual de Campinas
Ethics committee: cepUnicamp
Reason not required: The article is a Meta-analysis
All authors, affiliations and abstracts have been published as submitted.
