title: Predictive value of General Movement Assessment for preterm infants' development at 2 years - implementation in clinical routine in a non-academic setting.
abstract: BACKGROUND
  General movements (GM) are used in academic settings to predict developmental outcome in infants born preterm. However, little is known about the implementation and predictive value of GM in non-academic settings.
  
  
  OBJECTIVE
  The aim of this study is twofold: To document the implementation of GM assessment (GMA) in a non-academic setting and to assess its predictive value in infants born preterm.
  
  
  METHODS
  We documented the process of implementing GMA in a non-academic outpatient clinic. In addition, we assessed the predictive value of GMA at 1 and 3 months' corrected age for motor and cognitive development at 2 years in 122 children born <33 weeks' gestation. Outcome at two years was based upon the Bayley Scales of Infant Development-II (mental/psychomotor developmental index (MDI, PDI)) and a neurological examination. The infants' odds of atypical outcome (MDI or PDI ≤70 or diagnosis CP) and the predictive accuracy of abnormal GMA were calculated in a clinical routine scenario, which used all available GM information (primarily at 3 months or at 1 month, when 3 months were not available). In addition, separate analysis was undertaken for the samples of GMA at 1 and 3 months.
  
  
  RESULTS
  Tips to facilitate GMA implementation are described. In our clinical routine scenario, children with definitely abnormal GM were more likely to have an atypical two-year outcome than children with normal GM (OR 13.2 (95% CI 1.56; 112.5); sensitivity 55.6%, specificity 82.1%). Definitely abnormal GM were associated with reduced MDI (-12.0, 95% CI -23.2; -0.87) and identified all children with cerebral palsy (CP) in the sample of GMA at 3 months only.
  
  
  CONCLUSIONS
  GMA can be successfully implemented in a non-academic outpatient setting. In our clinical routine scenario, GMA allowed for adequate prediction of neurodevelopment in infants born preterm, thereby allaying concerns about diagnostic accuracy in non-academic settings.
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Ludolf-Krehl Strasse 7-11, 68167 Mannheim, Germany; Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany. Electronic address: freia.debock@medma.uni-heidelberg.de.
authors.forename: Freia
authors.initials: F
authors.lastname: De Bock
authors.affiliation: Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Will
authors.affiliation: Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Behrenbeck
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Ludolf-Krehl Strasse 7-11, 68167 Mannheim, Germany.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Jarczok
authors.affiliation: University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital - Institute of Developmental Neurology, Hanzeplein 1, 9713 GZ Groningen, Netherlands.
authors.forename: Mijna
authors.initials: M
authors.lastname: Hadders-Algra
authors.affiliation: Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Philippi
mesh_terms: D002547:Cerebral Palsy / Q000453:epidemiology*; D002657:Child Development; D002675:Child, Preschool; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007234:Infant, Premature; D008297:Male; D009043:Motor Activity; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D018570:Risk Assessment
keywords: Clinical routine; General movements; Mental development; Motor development; Preterm infant; Sensitivity