Cramped synchronized general movements in preterm infants as an early marker for cerebral palsy.
OBJECTIVE
To ascertain whether specific abnormalities (ie, cramped synchronized general movements [GMs]) can predict cerebral palsy and the severity of later motor impairment in preterm infants affected by brain lesions.


METHODS
Traditional neurological examination was performed, and GMs were serially videotaped and blindly observed for 84 preterm infants with ultrasound abnormalities from birth until 56 to 60 weeks' postmenstrual age. The developmental course of GM abnormalities was compared with brain ultrasound findings alone and with findings from neurological examination, in relation to the patient's outcome at age 2 to 3 years.


RESULTS
Infants with consistent or predominant (33 cases) cramped synchronized GMs developed cerebral palsy. The earlier cramped synchronized GMs were observed, the worse was the neurological outcome. Transient cramped synchronized character GMs (8 cases) were followed by mild cerebral palsy (fidgety movements were absent) or normal development (fidgety movements were present). Consistently normal GMs (13 cases) and poor repertoire GMs (30 cases) either lead to normal outcomes (84%) or cerebral palsy with mild motor impairment (16%). Observation of GMs was 100% sensitive, and the specificity of the cramped synchronized GMs was 92.5% to 100% throughout the age range, which is much higher than the specificity of neurological examination.


CONCLUSIONS
Consistent and predominant cramped synchronized GMs specifically predict cerebral palsy. The earlier this characteristic appears, the worse is the later impairment.
Ferrari
Fabrizio
F
Institute of Paediatrics and Neonatal Medicine, University of Modena, Policlinico Universitario, 41100 Modena, Italy. ferrarif@unimo.it
Cioni
Giovanni
G
Einspieler
Christa
C
Roversi
M Federica
MF
Bos
Arend F
AF
Paolicelli
Paola B
PB
Ranzi
Andrea
A
Prechtl
Heinz F R
HF
D002547:Cerebral Palsy / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies