Trajectories of general movements from birth to term-equivalent age in infants born <30 weeks' gestation

Abstract

Background: General movements (GMs) is an assessment with good predictive validity for neurodevelopmental outcomes in preterm infants. However, there is limited information describing the early GMs of very preterm infants, particularly prior to term. Aims: To describe the early GMs trajectory of very preterm infants (born < 30 weeks' gestation) from birth to term-equivalent age, and to assess the influence of known perinatal risk factors on GMs. Study design: Prospective cohort study. Subjects: 149 very preterm infants born <30 weeks' gestation. Outcome measures: GMs were recorded weekly from birth until 32 weeks' postmenstrual age, and then fortnightly until 38 weeks' postmenstrual age. GMs were also assessed at term-equivalent age. Detailed perinatal data were collected. Results: Of 669 GMs assessed, 551 were preterm and 118 were at term-equivalent age. Prior to term, 15% (n = 82) of GMs were normal and 85% (n = 469) were abnormal, with the proportion of abnormal GMs decreasing with increasing postmenstrual age (p for trend < 0.001). By term-equivalent 30% (n = 35) of GMs were normal. On univariable analysis, lower gestational age (p < 0.001), postnatal infection (p < 0.001) and bronchopulmonary dysplasia (p = 0.001) were associated with abnormal GMs. Postnatal infection was the only independent perinatal association with abnormal GMs on multivariable analysis. All four infants with grade III/IV intraventricular haemorrhage (IVH) had persistently abnormal GMs. Conclusions: GMs were predominantly abnormal in very preterm infants, with a higher proportion of normal GMs at term-equivalent age than prior to term. Abnormal GMs were associated with postnatal infection and IVH.