Comparison between the General Movements Assessment and the Alberta Infant Motor Scale in newborns and infants at risk for motor development alterations

Introdução: O aperfeiçoamento da assistência pré-natal e neonatal contribuiu para maior sobrevida dos recém-nascidos com riscos para alterações do desenvolvimento. A detecção precoce e eficaz destes riscos é fundamental para a intervenção oportuna e minimização dos danos funcionais. A avaliação com melhor valor preditivo para anormalidades é pelos General Movements (GMs), porém a mais utilizada no Brasil é a Escala Motora Infantil de Alberta (EMIA). Objetivo: Verificar a validade dos GMs e da EMIA com um e três meses de idade para predizer o desfecho do desenvolvimento motor pela EMIA aos seis e 12 meses. Método: Estudo observacional longitudinal com 45 recém-nascidos e lactentes do Hospital Universitário da Universidade de São Paulo, avaliados do nascimento até os cinco meses de idade (corrigida, se prematuros) pelos GMs, e de um a 12 meses pela EMIA. Foi realizada análise descritiva e testes de kappa e curva roc para a comparação entre as avaliações. Resultados: Os participantes (masculino = 51,1%) apresentaram idade gestacional média de 34 semanas; 57,7% apresentaram alteração em pelo menos uma avaliação pelos GMs, com predomínio do repertório pobre (RP) e fidgety movements (FM) ausentes, enquanto 46,6% apresentaram alguma alteração na EMIA. A maioria (85,7%) apresentou avaliações normais aos 12 meses de idade pela EMIA; e os com avaliações anormais também tiveram GMs alterados em toda sua trajetória. Houve pobre confiabilidade entre os GMs e a EMIA no primeiro (kappa: 0,165) e no terceiro mês, ligeira confiabilidade (kappa: 0,259). Comparando os writhing movements (WM) com a EMIA com um mês, para prever desfecho aos seis meses de idade, foi encontrado uma sensibilidade dos WM de 78,6% e uma especificidade de 100%. Valores melhores de sensibilidade e especificidade também foram encontrados nos WM para desfecho com 12 meses de idade (sensibilidade de 75% e especificidade em 100%). Os lactentes que apresentavam alguma alteração nas avaliações eram encaminhados para fisioterapia. Conclusão: Foi possível observar um grande número de participantes com GMs alterados, porém com diminuição/normalização nas avaliações pela EMIA, podendo ser devido a intervenção fisioterapêutica nos casos mais graves. A avaliação com melhores valores para predição do desenvolvimento são os GMs na fase dos WMs. Não existe correlação entre a avaliação dos GMs com 1 mês e EMIA 1 com mês, nem entre estes dois métodos aos 3 mesesIntroduction: Improvement of prenatal and neonatal care has contributed to a greater survival of newborns with risks for developmental disorders. Early and effective detection of these risks is essential for timely intervention and minimization of functional impairment. The most predictive value for abnormalities is the General Movements (GMs), but the most used in Brazil is the Alberta Infant Motor Scale (AIMS). Objective: To verify the validity of GMs and EMIA at one and three months of age to predict the outcome of motor development by EMIA at six and 12 months. Method: A longitudinal observational study with 45 newborns and infants of the University Hospital of the University of São Paulo, evaluated from birth to five months of age (corrected, if premature) by GMs, and from one to 12 months by EMIA. Descriptive analysis and kappa and roc curve tests were performed to compare the evaluations. Results: Participants (male = 51.1%) had a mean gestational age of 34 weeks; 57.7% presented alterations in at least one evaluation by GMs, with a predominance of poor repertoire (RP) and fidgety movements (FM) absent, while 46.6% had some alteration in EMIA. The majority (85.7%) presented normal evaluations at 12 months of age by EMIA; And those with abnormal ratings also had altered GMs throughout their trajectory. There was poor reliability between GMs and EMIA in the first (kappa: 0.165) and in the third month, slight reliability (kappa: 0.259). Comparing writhing movements (WM) with EMIA at one month, to predict outcome at six months of age, a WM sensitivity of 78.6% and a specificity of 100% was found. Better sensitivity and specificity values were also found in WM for 12-month-old outcome (75% sensitivity and 100% specificity). Infants who presented some alterations in the assessments were referred to physical therapy. Conclusion: It was possible to observe a large number of participants with altered GMs, but with a decrease / normalization in the evaluations by EMIA, and may be due to physiotherapeutic intervention in the most severe cases. The best predictive values for development prediction are GMs in the WM phase. There is no correlation between the evaluation of GMs at 1 month and EMIA 1 with month, nor between these two methods at 3 month

Association of Infants Exposed to Prenatal Zika Virus Infection With Their Clinical, Neurologic, and Developmental Status Evaluated via the General Movement Assessment Tool

Importance: There is an urgent need to assess neurodevelopment in Zika virus (ZIKV)-exposed infants. Objectives: To perform general movement assessment (GMA) at 9 to 20 weeks' postterm age and to evaluate whether the findings are associated with neurodevelopmental outcomes at age 12 months in infants prenatally exposed to acute maternal illness with rash in Brazil during the ZIKV outbreak and in age-matched controls. Design, Setting, and Participants: In this cohort study, infants prenatally exposed to acute maternal illness with rash were recruited at medical institutions in Rio de Janeiro and Belo Horizonte, Brazil, from February 1, 2016, to April 30, 2017, while infants without any exposure to maternal illness originated from the Graz University Audiovisual Research Database for the Interdisciplinary Analysis of Neurodevelopment. Participants were 444 infants, including 76 infants without congenital microcephaly, 35 infants with microcephaly, and 333 neurotypical children matched for sex, gestational age at birth, and age at GMA. Main Outcomes and Measures: General movement assessment performed at 9 to 20 weeks' postterm age, with negative predictive value, positive predictive value, sensitivity, and specificity generated, as well as clinical, neurologic, and developmental status (Bayley Scales of Infant and Toddler Development, Third Edition [Bayley-III] scores) at age 12 months. Motor Optimality Scores were generated based on the overall quality of the motor repertoire. Adverse outcomes were defined as a Bayley-III score less than 2 SD in at least 1 domain, a score less than 1 SD in at least 2 domains, and/or atypical neurologic findings. Results: A total of 444 infants were enrolled, including 111 children prenatally exposed to a maternal illness with rash and 333 children without any prenatal exposure to maternal illness (57.7% male and mean [SD] age, 14 [2] weeks for both groups); 82.1% (46 of 56) of ZIKV-exposed infants without congenital microcephaly were healthy at age 12 months. Forty-four of 46 infants were correctly identified by GMA at 3 months, with a negative predictive value of 94% (95% CI, 85%-97%). Seven of 10 ZIKV-exposed children without microcephaly with adverse neurodevelopmental outcomes were identified by GMA. The GMA positive predictive value was 78% (95% CI, 46%-94%), sensitivity was 70% (95% CI, 35%-93%), specificity was 96% (95% CI, 85%-99%), and accuracy was 91% (95% CI, 80%-97%). Children with microcephaly had bilateral spastic cerebral palsy; none had normal movements. The Motor Optimality Score differentiated outcomes: the median Motor Optimality Score was 23 (interquartile range [IQR], 21-26) in children with normal development, 12 (IQR, 8-19) in children with adverse outcomes, and 5 (IQR, 5-6) in children with microcephaly, a significant difference (P = .001). Conclusions and Relevance: This study suggests that although a large proportion of ZIKV-exposed infants without microcephaly develop normally, many do not. The GMA should be incorporated into routine infant assessments to enable early entry into targeted treatment programs.</p