General Movement Assessment for predicting the neurodevelopmental outcomes in cohort of infants exposed to severe hyperbilirubinemia and hypoxic ischaemic encephalopathy respectively in the neonatal period

Objectives: We studied infants exposed to severe hyperbilirubinemia and Hypoxic Ischaemic Encephalopathy (HIE) in the neonatal period and assessed their General Movements (GMs) and evaluated their (GMs) ability to predict future neurodevelopment. Methods: first cohort of Term and late preterm infants exposed to severe hyperbilirubinemia in the initial 2 weeks of life and and second cohort of term newborns exposed to HIE were recruited and GMA (General Movement Assessment) were done at 50-56 weeks post menstrual age by two independent blinded certified GMA reviewers. Neurodevelopmental Outcomes were assessed on basis of neurological examination and standard neurodevelopmental scales at 1 year of age. Result: For the infants exposed to severe hyperbilirubinemia, out of 44 infants, 8 had abnormal fidgety (Absent and/or Abnormal) and rest had normal fidgety movements. All infants with abnormal fidgety GMs had adverse neurodevelopmental outcomes and among 36 infants with normal GMs, 33 were normal at 1 year of age, and 3 had mild developmental delay. Among the infants exposed to HIE, out of 30 infants, Among 19 babies with normal fidgety movement, 17 had normal developmental . In the absent fidgety movement group 10/11have abnormal neurodevelopmental outcomes. Conclusion: GMA have excellent predictive value for predicting neurodevelopment and occurrence of dyskinetic and spastic CP in this specialized population of neonates exposed to severe hyperbilirubinemia and HIE respectively. It is an amazing non-invasive tool to predict neurodevelopmental outcomes and to take full advantage of brain plasticity by initiating early intervention and could be a gamechanger in neurorehabilitation.
Keywords: General movements, kernicterus, HIE, Cerebral palsy, fidgety