Neurodevelopmental Outcome of High-Risk Neonates At 24 Months of Age, With Respect to General Movements of Prechetl at Term or Within 3 Months of Age

Abstract

Background: Advances in secondary and tertiary level neonatal care in India and the state of Kerala have resulted in better survival and reduction of mortality of high risk neonates. So it is essential to have follow up of these babies more frequently and start early interventions to prevent or reduce the severity of developmental delay. Various non- invasive, cost effective methods are being tried to detect or predict early the developmental delay, one among these methods is general movements of Prechetl, since only a small percentage of neonates with risk factors are developing significant developmental delay later.

Methods: Neonates 25 weeks and above, but less than 42 weeks, admitted with risk factors and discharged, presenting for follow up within 3 months of age were enrolled for the study. Those babies having visible birth defects (VBD), chromasomal or other genetic disorders, and dysmorphic or syndromic features were excluded from the study. Neonates at term or their first visit within 3 months were observed for general movements of Prechetl when the baby is remaining alert without crying and noted as normal or absent/abnormal. These high risk babies (N=375) in this prospective observational analytic study were followed up to their completed or corrected 24 months of age. Neurodevelopmental assessment done in domains- cognitive, communication,
motor, and social-emotional at 24 months using Bayley scales of infant and toddler development edition-3 (BSID-III). The study was conducted over a period of 6 years from 2017 in south of middle Kerala, India.

Results: Out of total 375 high risk babies, 53 babies were having abnormal/absent general movements pattern of Prechetl and 322 had normal general movements pattern. High risk babies with absent/abnormal general movements cohort babies were having significantly lower total and domain-wise (cognitive, language, motor and social-emotional) developmental scores compared to high risk babies with normal general movements pattern cohort at their corrected/completed 24 months of age, using BSID-III indicating higher chance for babies with absent/abnormal general movements to have moderate to severe developmental delay and cerebral palsy at 24 months of age.

Conclusion: Abnormal or absent general movements pattern at term or within 3 months of age of high risk infants are associated with high chance of moderate to severe developmental delay and cerebral palsy at their corrected/completed 24 months of age, compared to high risk infants with normal general movements pattern, at term or within 3 months of age.