Published online April 7, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. e1184-e1189 (doi:10.1542/peds.2007-1924)

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ARTICLE

Quality of General Movements Is Related to White Matter Pathology in Very Preterm Infants

Alicia J. Spittle, MSc, BPhysio^a,b,d, Nisha C. Brown, PhD^a,c,d, Lex W. Doyle, MD, FRACP^a,b,c,d, Roslyn N. Boyd, PhD, MSc, Physio^a,b,e, Rod W. Hunt, MMed, FRACP^a,c, Merilyn Bear, RM, BN^a,d and Terrie E. Inder, MD, MBChB^a,f,g

^a Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Australia
Departments of ^b Paediatrics
^c Obstetrics and Gynaecology
^g Howard Florey Institute, University of Melbourne, Melbourne, Australia
^d Division of Newborn Services, Royal Women's Hospital, Melbourne, Australia
^e Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland, Brisbane, Australia
^f Department of Pediatrics, Neurology, and Radiology, St Louis Children's Hospital, Washington University, St Louis, Missouri

OBJECTIVE. Preterm infants are at an increased risk for abnormalities of general movements, which predict subsequent poor neurodevelopmental outcome. The cerebral lesion that predisposes the preterm infant to abnormal general movements remains unknown. The objective of this study was to determine the association between MRI-defined cerebral abnormalities and general movements at 1 and 3 months' corrected age in infants who were born very preterm.

METHODS. Eighty-six preterm infants (<30 weeks' gestation) were prospectively recruited and underwent brain MRI at term-equivalent age to investigate the relationship between qualitative white and gray matter pathology and abnormality of general movements. Standardized videotaped recordings of general movements were obtained at 1 and 3 months postterm (±1 week) and scored without knowledge of the MRI findings. At 1 month corrected age, general movements of a writhing character were classified as normal or abnormal (poor repertoire, cramped synchronized, or chaotic). At 3 months' corrected age, fidgety general movements were classified as present or absent.

RESULTS. At 1 month, 53 (62%) infants had abnormal general movements, 46 of whom had poor repertoire general movements and 7 of whom had cramped synchronized general movements. At 3 months, 23 (25%) infants had absent fidgety movements. At both 1 and 3 months of age, consistently abnormal general movement classifications were related to increasing white matter abnormality on MRI. In contrast, there were no significant relationships between general movement classifications and gray matter abnormalities, either individually or in total.

CONCLUSION. The significant relationships between general movements at 1 and 3 months and cerebral white matter abnormalities on MRI in the very preterm infant support the concept that abnormal general movements reflect white matter injury.

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Key Words: developmental follow-up • magnetic resonance • neuromotor outcome • preterm infants

Abbreviations: GM—general movement • IVH—intraventricular hemorrhage • PVL—periventricular leukomalacia

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Accepted Oct 1, 2007.

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