Published online January 26, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. 512-517 (doi:10.1542/peds.2008-0590)

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ARTICLE

Predicting Motor Development in Very Preterm Infants at 12 Months’ Corrected Age: The Role of Qualitative Magnetic Resonance Imaging and General Movements Assessments

Alicia J. Spittle, MPhysio, BAppSc^a,b,c,d, Roslyn N. Boyd, PhD, MSc, BAppSc, BSc^c,e, Terrie E. Inder, MBChB, MD^a,f and Lex W. Doyle, MD, FRACP^a,c,d,g

^a Victorian Infant Brain Studies, Murdoch Childrens Research Institute, Melbourne, Australia
^b School of Physiotherapy, Departments of
^c Pediatrics
^g Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia
^d Royal Women's Hospital, Melbourne, Australia
^e Queensland Cerebral and Rehabilitation Research Center, University of Queensland, Queensland, Australia
^f Departments of Pediatrics, Neurology and Radiology, St Louis Children's Hospital, Washington University, St Louis, Missouri

OBJECTIVE. The objective of this study was to compare the predictive value of qualitative MRI of brain structure at term and general movements assessments at 1 and 3 months' corrected age for motor outcome at 1 year's corrected age in very preterm infants.

PATIENTS AND METHODS. Eighty-six very preterm infants (<30 weeks' gestation) underwent MRI at term-equivalent age, were evaluated for white matter abnormality, and had general movements assessed at 1 and 3 months' corrected age. Motor outcome at 1 year's corrected age was evaluated with the Alberta Infant Motor Scale, the Neuro-Sensory Motor Development Assessment, and the diagnosis of cerebral palsy by the child's pediatrician.

RESULTS. At 1 year of age, the Alberta Infant Motor Scale categorized 30 (35%) infants as suspicious/abnormal; the Neuro-Sensory Motor Development Assessment categorized 16 (18%) infants with mild-to-severe motor dysfunction, and 5 (6%) infants were classified with cerebral palsy. White matter abnormality at term and general movements at 1 and 3 months significantly correlated with Alberta Infant Motor Scale and Neuro-Sensory Motor Development Assessment scores at 1 year. White matter abnormality and general movements at 3 months were the only assessments that correlated with cerebral palsy. All assessments had 100% sensitivity in predicting cerebral palsy. White matter abnormality demonstrated the greatest accuracy in predicting combined motor outcomes, with excellent levels of specificity (>90%); however, the sensitivity was low. On the other hand, general movements assessments at 1 month had the highest sensitivity (>80%); however, the overall accuracy was relatively low.

CONCLUSION. Neuroimaging (MRI) and functional (general movements) examinations have important complementary roles in predicting motor development of very preterm infants.

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Key Words: cerebral palsy • motor development • MRI • neonatal • premature infants

Abbreviations: PVL—periventricular leucomalacia • WMA—white matter abnormality • GMs—general movements • AIMS—Alberta Infant Motor Scale • NSMDA—Neuro-Sensory Motor Developmental Assessment • CI—confidence interval

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Accepted May 5, 2008.

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