Prediction of neurodevelopment at one year of age using the General Movements assessment in the neonatal surgical population.

BACKGROUND: Recent evidence indicates neonatal surgery is associated with an increased risk of neurodevelopmental disability, including cerebral palsy (CP). Despite evidence for prediction of CP there is limited information on use of the General Movements Assessment (GMA) with this population.

AIM: To investigate the utility of the GMA for prediction of neurodevelopment in an infant surgical population.

STUDY DESIGN: Prospective cohort study Subjects: 278 infants following cardiac surgery (n = 149), non-cardiac surgery (n = 123) or both surgeries (n = 6).

OUTCOME MEASURES: GMA at three months of age (mean 12 weeks, SD 1.6) rated by three assessors, two blinded to clinical details. Follow-up at one year of age (mean 372 days, SD 13) using Bayley Scales of Infant and Toddler Development III (BSID-III), clinical and neurological examination.

RESULTS: At one year, none of the 248 (89%) infants with normal fidgety movements had a diagnosis of CP, however a large proportion (n = 118, 48%) demonstrated delayed development. Infants who had absent fidgety movements (n = 25, 9%) showed a significant difference on all subtests of the BSID-III (p > 0.05). For prediction of CP there was 100% sensitivity and 96% specificity.

CONCLUSIONS: The GMA is a valid complementary assessment tool to enhance prediction of neurodevelopment, specifically CP, following early neonatal surgery and should be incorporated into routine follow-up for this population.