52 - General Movements Assessment: A Tool for Early Neurodevelopmental Risk Identification in the NICU

Publication Number: 1045.52

Mariam M. Sharfi, Eastern Virginia Medical School, Norfolk, VA, United States; Jourdan Sturges, Eastern Virginia Medical School, Norfolk, VA, United States; Carlos Rodrigo Castro-Castaneda, Children's Hospital of The King's Daughters, Norfolk, VA, United States; Aliyah Mohammed, Children's Hospital of The King's Daughters, Norfolk, VA, United States; Kayla Distin, Eastern Virginia Medical School, Norfolk, VA, United States; Lindsay Schuler, Children's Hospital of The King's Daughters, Norfolk, VA, United States; Kelly Crombie, Children's Hospital of The King's Daughters, Norfolk, VA, United States; Christine Houlihan, Children's Hospital of The King's Daughters, Norfolk, VA, United States; Turaj Vazifedan, Eastern Virginia Medical School, Norfolk, VA, United States; Haree Pallera, Children's Hospital of The King's Daughters / Eastern Virginia Medical School, Norfolk, VA, United States; Tushar Shah, Children's Specialty Group, Norfolk, VA, United States

Background: The Prechtl General Movements Assessment (GMA) is a visual screening method designed to detect infants at elevated risk for neurodevelopmental delays and cerebral palsy. Early recognition of these infants enables prompt initiation of targeted interventions to enhance long-term developmental outcomes. Prior to introducing the GMA, the standard approach at our institution for identifying high-risk infants relied on serial cranial ultrasounds and brain MRIs when neurological abnormalities were observed.

Objective: This study aims to integrate the GMA as an additional screening tool to improve early detection of infants at risk for neurological impairment.

Design/Methods: Starting in 2024, GMA testing was implemented on all babies admitted to the level 4 NICU. Under an IRB-approved protocol, data about GMA testing and risk factors were collected including delivery details, GA, BW, IVH, NEC, HIE seizures, and BPD. Available neuroimaging data was reviewed. Movements were characterized as normal or abnormal (cramped-synchronized, poor repertoire, absent fidgety movements). Univariate and multivariate regression analyses were performed to correlate risk factors with GMA results.

Results: A total of 285 infants were eligible for GMA testing. 25 medically unstable infants were excluded from preterm writhing GMA. In univariate analysis (Table 1), gestational age less than 28 weeks at birth was associated with decreased odds of normal movements and an increased likelihood of absent fidgety movements. Infants with NEC had a higher likelihood of abnormal fidgety movements. Among HIE patients, seizures were associated with decreased odds of normal movements, and a normal EEG was associated with increased odds of normal movements. Infants with BPD had decreased odds of normal fidgety movements. In a multivariate logistic regression model, the likelihood of normal movements was significantly lower among subjects with BPD and HIE, after controlling for confounders such as gestational age, sex, IVH, HIE, NEC, and abnormal neuroimaging (Table 2). The likelihood of normal fidgety movements was significantly lower among those with NEC.

Conclusion(s): Institution of GMA as standard practice in our institution's NICU is aiding in early detection of potential risk factors for abnormal neurodevelopment such as BPD, HIE, and NEC. Longitudinal data collection is ongoing. Infants identified as high risk are seen by physical therapists in a GMA clinic, resulting in early institution of intensive therapies and requisite referrals with the goal of improving long-term functional outcomes.

Table 1
Univariate analysis of risk factors for abnormal movements on GMA

Table 2
Multivariate logistic regression to identify risk factors for abnormal movements on GMA