Hand movements at 3 months predict later hemiplegia in term infants with neonatal cerebral infarction.
OBJECTIVE
The aim of this study was to explore the predictive value of quantitative assessment of hand movements in 3-month-old infants after neonatal stroke.


METHODS
Thirteen infants born at term (five females, eight males; mean gestational age 39.4wks, SD 1.19, range 37-41wks; mean birthweight 3240g, SD 203, range 2900-3570g) with neonatal arterial ischaemic cerebral infarction, and 13 healthy infants (mean gestational age 39.1wks, range 37-41wks, SD 1.26; mean birthweight 3190g, SD 259, range 2680-3490g) were enrolled in the study. The absolute frequency and the asymmetry of global hand opening and closing, wrist segmental movements, and independent digit movements were assessed from videotapes recorded at around 12 weeks. Neurological outcome was assessed when the infants were at least 18 months old using Touwen's neurological examination.


RESULTS
Five of the 13 infants with neonatal stroke had normal neurological development, and eight had hemiplegia. Asymmetry of wrist segmental movements and the absolute frequency of independent digit movements were significantly different between infants with and without hemiplegia (p=0.006 and p=0.008, respectively). No differences were found in global hand movements.


CONCLUSIONS
We propose that the observed abnormalities of hand movements are the result of two different mechanisms: direct disruption of the corticospinal projection to the spinal cord, and altered modulation of the central pattern generators of general movements.
Department of Developmental Neuroscience, Scientific Institute Stella Maris, Calambrone, Pisa, Italy.
Andrea
A
Guzzetta
Alessandra
A
Pizzardi
Vittorio
V
Belmonti
Antonio
A
Boldrini
Marco
M
Carotenuto
Giulia
G
D'Acunto
Fabrizio
F
Ferrari
Simona
S
Fiori
Claudio
C
Gallo
Paolo
P
Ghirri
Eugenio
E
Mercuri
Domenico
D
Romeo
Maria Federica
MF
Roversi
Giovanni
G
Cioni
D001921:Brain / Q000098:blood supply* / Q000503:physiopathology*; D002545:Brain Ischemia / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D005865:Gestational Age; D006225:Hand / Q000503:physiopathology*; D006429:Hemiplegia / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009069:Movement Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index