General movements as a predictive tool of the neurological outcome in very low and extremely low birth weight infants--a South African perspective.

BACKGROUND: At a time of increasing demands on South African limited healthcare resources, there is a need for an assessment method that can reliably predict neurological deficits in high-risk infants at an early age.

OBJECTIVE: The objective of the study is to determine whether the qualitative assessment of fidgety movements will predict the neurological outcome of very low birth weight and extremely low birth weight infants admitted to Tygerberg Children's Hospital (TCH), Cape Town, South Africa.

METHODOLOGY: A prospective descriptive study was conducted using Prechtl's method of qualitative assessment of fidgety movements at three months corrected age (CA). The study sample consisted of 115 infants, with a birth weight of ≤1250 g each. At 12 months CA, the infants' final motor outcome was classified as normal, abnormal or suspect according to assessments undertaken in line with those of Amiel-Tison and Gosselin, the Peabody Developmental Motor Scale and the Alberta Infant Motor Scale (AIMS).

RESULTS: A significant relationship was found (ρ<0.01) between fidgety movement outcome and the infants' final motor outcome at 12 months corrected age, with a sensitivity of ≥71%, a specificity of ≥89%, a positive predictive value of ≥80%, and a negative predictive value of ≥96%.

CONCLUSIONS: The results of the study indicated that Prechtl's qualitative method of fidgety movement assessment, as used in a clinical setting, is a highly sensitive and specific predictor of neurological outcome in preterm infants, which might effectively be used at TCH.