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Selected Publication:

Kober, R.
Global and detailed “General Movement Assessment” in the case of premature infants with periventricular leukomalacia°I
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2018. pp. [OPEN ACCESS]


Authors Med Uni Graz:
Pansy Jasmin
Urlesberger Berndt

Premature infants have an increased risk for prenatal and perinatal brain damage, for which development of periventricular leukomalacia (PVL) is regarded as a relevant risk factor. According to the literature, there are four degrees of severity (PVL°I to °IV). Even low-grade PVL can cause cerebral palsy (CP) in a third of children. Thus, counseling sessions with parents of children diagnosed with PVL°I are challenging. The assessment of spontaneous movements (General Movement Assessment, GMA) is a reliable method for early detection of neurologic dysfunction, especially the emergence of a CP. We examined weather the infants with sonographically verified PVL°I have abnormal General Movements (GMs). In a retrospective observational study, premature infants with sonographically verified PVL°I were matched with a 1:2 ratio with infants that had a normal brain ultrasound according to gender (63% male), gestational age (±1 week) and body weight (±660g). The clinical and demographic data were elicited from the patient files. Video recordings made before discharge and at a corrected age of 3 months were analyzed using global and detailed GMA (General Movement Optimality Score GMOS around term, and Motor Optimality Score (MOS) at corrected age of 3 months). The persons who analysed the videos were blinded to group affiliation. Between 2014 and 2016, 11 infants (GA 33+-3 SSW, GG 1300g (762-3200)) were diagnosed with PVL°I at the University Hospital of Graz. These infants were matched with 22 premature infants (GA 30+-3 SSW, GG 1320g (600-2630)) without PVL. Before discharge, 1 infant could not be analyzed (PVL group). The global GMA showed minor abnormalities (Poor Repertoire, PR) for 8/10 infants with PVL°I (80%) and normal findings for 2. Infants without PVL showed abnormalities (PR) in 12/20 cases (60%). The GMOS of infants with PVL°I (median GMOS 24 (range 16-37)) was significantly lower than for infants without PVL (median GMOS 30 (range 14-42. p<0.05). At 3 months all infants had normal GMs. All infants showed Fidgety Movements and the MOS of infants with PVL°I of 28 (range 21-28) vs. 26 (range 22-28) of infants without PVL differed not significantly. At the time of discharge, infants with PVL°I showed more frequently conspicuous GMs (PR) and a significantly lower GMOS compared to infants without PVL. In the corrected age of 3 months, all infants had normal GMs. No differentiation of the MOS between the groups was verifiable. It remains unclear, whether one of the infants will have a CP. This analysis will have to be made in the future.

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