PROCENA SPONTANE MOTORIČKE AKTIVNOSTI U PREDIKCIJI NORMALNOG NEUROMOTORIČKOG RAZVOJA KOD PREMATURUSA
Sažetak
Konvencionalne metode neurološke procene novorođenčadi i odojčadi upotrebljavaju se u svakodnevnoj kliničkoj praksi. Budući da kod prevremeno rođene dece postoji više faktora rizika za nastanak neuromotoričkih razvojnih poremećaja, cilj ovog istraživanja bio je da se utvrdi prediktivna vrednost spontane motoričke aktivnosti za normalan neurološki i funkcionalni ishod u uzrastu od 24 meseca kod prevremeno rođene dece u tzv. fidgety periodu.
Studija je sprovedena kao prospektivna klinička studija i obuhvatila je osamdesetoro prevremeno rođene dece. Procena spontane motoričke aktivnosti vršena je prema osnovnim principima Prechtlove metode u periodu od 50. do 54. nedelje postmenstrualnog uzrasta.
Svi ispitanici kod kojih su evidentirani normalni fidgety pokreti imali su i uredan neuromotorički nalaz u uzrastu od 24 meseca. Među decom koja su kao konačan neurološki ishod imala nalaz minimalne neurološke disfunkcije nakon 24 meseca, 73% njih pokazalo je abnormalne fidgety pokrete. U istraživanju nije bilo ispitanika kod kojih je uočena normalna prezentacija fidgety pokreta, a kod kojih su u uzrastu od 24 meseca evidentirani neurološki deficit i klinička slika koja ide u prilog kasnijem razvoju cerebralne paralize. Veće šanse za razvoj neurorazvojne devijacije imaju deca rođena pre termina sa (veoma) malom porođajnom težinom, prematurusi rođeni pre 30. gestacijske nedelje, kao i deca sa niskim vrednostima Apgar skora.
Visoka prediktivna vrednost nalaza normalne spontane motoričke aktivnosti u periodu od 50. do 54. nedelje postmenstrualne starosti potvrđuje praktičnu važnost procene spontane motoričke aktivnosti i potrebu za praćenjem razvoja sve prevremeno rođene dece.
Reference
Alonzo CJ, Letzkus LC, Connaughton EA, Kelly NL, Michel JA, et al. High prevalence of abnormal general movements in hospitalized very low birth weight infants. Am J Perinatol 2022;29(14):1541-7. [CrossRef][PubMed]
Burger M, Louw QA. The predictive validity of general movements-a systematic review. Eur J Paediatr Neurol 2009;13:408-20. [CrossRef][PubMed]
Datta AN, Furrer MA, Bernhardt I, Hüppi PS, Borradori-Tolsa C, Bucher HU, et al. Fidgety movements in infants born very preterm: predictive value for cerebral palsy in a clinical multicentre setting. Dev Med Child Neurol 2017;59(6):618-24. [CrossRef][PubMed]
Dimitrijević L, Bjelaković B, Čolović H, Mikov A, Živković V, Kocić M, et al. Assessment of general movements and heart rate variability in prediction of neurodevelopmental outcome in preterm infants. Early Hum Dev 2016;99:7-12. [CrossRef][PubMed]
Domagalska-Szopa M, Szopa A, Serrano-Gómez ME, Hagner-Derengowska M, Behrendt J. Identification of risk factors in pre-term infants with abnormal general movements. Front Neurol 2022; 13:850877. [CrossRef][PubMed]
Einspieler C, Marschik PB, Bos AF, Ferrari F, Cioni G, Prechtl HF. Early markers for cerebral palsy: insights from the assessment of general movements. Future Neurol 2012;7:709-17. [CrossRef]
Einspieler C, Marschik PB, Milioti S, Nakajima Y, Bos AF, Prechtl HFR. Are abnormal fidgety movements an early marker for complex minor neurological dysfunction at puberty? Early Hum Dev 2007;83:521–5. [CrossRef][PubMed]
Einspieler C, Peharz R, Marschik P. Fidgety movements - tiny in appearance, but huge in impact. J Pediatr 2016;92(3 Suppl 1):S64-S70. [CrossRef][PubMed]
Einspieler C, Prechtl H, Bos, A, Ferrari F, Cioni G. Prechtl’s method on the qualitative assessment of general movements in preterm, term and young infants. London: Mac Keith Press; 2008.
Einspieler C, Yang H, Bartl-Pokorny KD, Chi X, Zang FF, Marschik PB, et al. Are sporadic fidgety movements as clinically relevant as is their absence. Early Hum Dev 2015;91:247-52. [CrossRef][PubMed]
Goyen TA, Morgan C, Crowle C, Hardman C, Day R, Novak I, et al. Sensitivity and specificity of general movements assessment for detecting cerebral palsy in an Australian context: 2-year outcomes. J Paediatr Child Health 2020;56(9):1414-8. [CrossRef][PubMed]
Harpster K, Merhar S, Priyanka Illapani VS, Peyton C, Kline-Fath B, Parikh NA. Associations between early structural magnetic resonance imaging, hammersmith infant neurological examination, and general movements assessment in infants born very preterm. J Pediatr 2021;232:80-6.e2. [CrossRef][PubMed]
Himpens E, Oostra A, Franki I, Van Maele G, Vanhaesebrouck P, Van den Broeck C. Predictability of cerebral palsy and its characteristics through neonatal cranial ultrasound in a high-risk NICU population. Eur J Pediatr 2010;169(10):1213-9. [CrossRef][PubMed]
Jung MW, Landenberger M, Jung T, Lindenthal T, Philippi H. Vojta therapy and neurodevelopmental treatment in children with infantile postural asymmetry: a randomised controlled trial. J Phys Ther Sci 2017;29(2):301-6. [CrossRef][PubMed]
Katušić A, Žunić Išasegi I, Radoš M, Raguž M, Grizelj R, Ferrari F, et al. Transient structural MRI patterns correlate with the motor functions in preterm infants. Brain Dev 2021;43(3):363-71. [CrossRef][PubMed]
Longo S, Caporali C, Pisoni C, Borghesi A, Perotti G, Tritto G, et al. Neurodevelopmental outcome of preterm very low birth weight infants admitted to an Italian tertiary center over an 11-year period. Sci Rep 2021;11(1):16316. [CrossRef][PubMed]
Morgan C, Crowle C, Goyen TA, Hardman C, Jackman M, Novak I, et al. Sensitivity and specificity of General Movements Assessment for diagnostic accuracy of detecting cerebral palsy early in an Australian context. J Paediatr Child Health 2016;52(1):54-9. [CrossRef][PubMed]
Porro M, Fontana C, Giannì ML, Pesenti N, Boggini T, De Carli A, et al. Early detection of general movements trajectories in very low birth weight infants. Sci Rep 2020;10(1):13290. [CrossRef][PubMed]
Prechtl HF, Cioni G, Einspieler C, Bos AF, Ferrari F. Role of vision on early motor development: lessons from the blind. Dev Med Child Neurol 2001;43(3):198-201. [CrossRef][PubMed]
Prechtl HF. Qualitative changes of spontaneous movements in fetus and preterm infant are a marker of neurological dysfunction. Early Hum Dev 1990;23:151-8. [CrossRef][PubMed]
Raghuram K, Orlandi S, Church P, Chau T, Uleryk E, Pechlivanoglou P, et al. Automated movement recognition to predict motor impairment in high-risk infants: a systematic review of diagnostic test accuracy and meta-analysis. Dev Med Child Neurol 2021;63(6):637-48. [CrossRef][PubMed]
Romeo DM, Guzzetta A, Scoto M, Cioni M, Patusi P, Mazzone D, et al. Early neurologic assessment in preterm-infants: integration of traditional neurologic examination and observation of general movements. Eur J Paediatr Neurol 2008;12:183-9. [CrossRef][PubMed]
Santos RS, Araújo AP, Porto MA. Early diagnosis of abnormal development of preterm newborns: assessment instruments. J Pediatr 2008;84:289-99. [CrossRef][PubMed]
Spittle AJ, Doyle LW, Boyd RN. A systematic review of the clinimetric properties of neuromotor assessments for preterm infants during the first year of life. Dev Med Child Neurol 2008;50:254-66. [CrossRef][PubMed]
Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE). Dev Med Child Neurol 2000;42(12):816-24. [CrossRef][PubMed]
Tacchino C, Impagliazzo M, Maggi E, Bertamino M, Blanchi I, Campone F, et al. Spontaneous movements in the newborns: a tool of quantitative video analysis of preterm babies. Comput Methods Programs Biomed 2021;199:105838. [CrossRef][PubMed]
Yuge M, Marschik PB, Nakajima Y, Yamori Y, Kanda T, Hirota H, et al. Movements and postures of infants aged 3 to 5 months: to what extent is their optimality related to perinatal events and to the neurological outcome? Early Hum Dev 2011;87:231-7. [CrossRef][PubMed]
Zlatanović D, Čolović H, Živković V, Kocić M, Stanković A, Vučić J, et al. Značaj Prehtlove metode u ultraranoj predikciji neuroloških abnormalnosti kod novorođenčadi i odojčadi. Acta Medica Medianae 2019;58(3):111-5. [CrossRef]
Zlatanovic D, Čolović H, Živković V, Stanković A, Kostić M, Vučić J, et al. The importance of assessing general motor activity in premature infants for predicting neurological outcomes. Folia Neuropathol 2022;60(4):427-35. [CrossRef][PubMed]
Zlatanović D. Procena spontane motoričke aktivnosti novorođenčeta i odojčeta (in Serbian) [dissertation]. Niš: Faculty of Medicine University of Niš; 2018.
