Background:

Clinical measures after birth and studies such as electroencephalogram (EEG) and brain imaging do not fully predict neurodevelopmental outcomes of infants with hypoxic-ischemic encephalopathy. Early detection of adverse neurologic outcomes, and cerebral palsy in particular, in high-risk infants is essential for ensuring timely management. The General Movements Assessment is a tool that can be used in the early detection of cerebral palsy in infants with brain injury. The majority of studies on the General Movements Assessment in the late preterm and term population were performed prior to the introduction of therapeutic hypothermia.

Aims:

To apply the General Movements Assessment in late preterm and term infants with hypoxic-ischemic encephalopathy (including those who received therapeutic hypothermia), to determine if clinical markers of hypoxic-ischemic encephalopathy predict abnormal General Movements Assessment findings, and to evaluate interrater reliability of the General Movements Assessment in this population. Study design: Pilot prospective cohort study Subjects: We assessed 29 late preterm and full-term infants with mild, moderate, and severe hypoxic-ischemic encephalopathy in Philadelphia, PA.

Results:

Most infants’ general movements normalized by the fidgety age. Only infants with moderate or severe hypoxic-ischemic encephalopathy had abnormal general movements in both the writhing and the fidgety ages (n = 6). Seizure at any point during the initial hospitalization was the clinical sign most predictive of abnormal general movements in the fidgety age (sensitivity 100%, specificity 55%, positive predictive value 40%, negative predictive value 100%). Interrater reliability was greatest during the fidgety age (κ = 0.67).

Conclusions:

Seizures were the clinical predictor most closely associated with abnormal findings on the General Movements Assessment. However, clinical markers of hypoxic-ischemic encephalopathy are not fully predictive of abnormal General Movements Assessment findings. Larger future studies are needed to evaluate the associations between the General Movements Assessment and childhood neurologic outcomes in patients with hypoxic-ischemic encephalopathy who received therapeutic hypothermia.

中文翻译：

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新生儿缺氧缺血性脑病的一般运动评估

背景：

出生后的临床测量以及脑电图 (EEG) 和脑成像等研究并不能完全预测缺氧缺血性脑病婴儿的神经发育结果。早期发现高危婴儿的不良神经系统结局，尤其是脑瘫，对于确保及时管理至关重要。一般运动评估是一种可用于早期发现脑损伤婴儿脑瘫的工具。大多数关于晚期早产和足月人群的一般运动评估的研究是在引入治疗性低温之前进行的。

目标：

将全身运动评估应用于患有缺氧缺血性脑病的晚期早产儿和足月婴儿（包括接受低温治疗的婴儿），以确定缺氧缺血性脑病的临床标志物是否可以预测异常的全身运动评估结果，并评估评估结果的评估者间可靠性该人群的一般运动评估。研究设计：试点前瞻性队列研究 对象：我们评估了宾夕法尼亚州费城的 29 名患有轻度、中度和重度缺氧缺血性脑病的晚期早产儿和足月儿。

结果：

大多数婴儿的一般运动因烦躁的年龄而正常化。只有患有中度或重度缺氧缺血性脑病的婴儿在扭动和烦躁的年龄（n = 6）都有异常的全身运动。在最初住院期间的任何时候癫痫发作是最能预测烦躁年龄异常全身运动的临床体征（敏感性 100%，特异性 55%，阳性预测值 40%，阴性预测值 100%）。在烦躁的年龄（κ = 0.67），评估者间的可靠性最高。

结论：

癫痫发作是与一般运动评估异常结果最密切相关的临床预测因子。然而，缺氧缺血性脑病的临床标志物并不能完全预测异常的全身运动评估结果。需要更大规模的未来研究来评估接受低温治疗的缺氧缺血性脑病患者的一般运动评估与儿童神经系统结局之间的关联。