554 - Prediction of Early Developmental Impairments Using Prechtl's General Movements Assessment and the Hammersmith Infant Neurologic Examination in High Risk Infants

Poster Number: 554
Publication Number: 554.2772

Background: The General Movement Assessment (GMA) and Hammersmith Infant Neurological Examination (HINE) are used at 3-5 months of corrected age (CA) to identify children at high risk for cerebral palsy (CP). These tests also may be useful to identify infants with early developmental delays, but this has not been well studied.

Objective: To assess associations between the GMA and/or HINE and developmental delays or CP at 6-12 months corrected age (CA) on the Bayley Scales of Infant-Toddler Development (BSITD) or the Developmental Assessment of Young Children (DAYC-2) in high risk infant graduates of the neonatal and cardiac intensive care units.

Design/Methods: Infants with neonatal risk factors born in 2020-2021 were included if they underwent early detection screening at 3-5 months CA using the GMA Motor Optimality Score, Revised (MOS-R) and/or the HINE (at the follow up clinic or in the hospital if not discharged) AND if they were assessed with either the BSITD (IV) or DAYC-2 at 6-12 months CA (during the pandemic the DAYC-2 was used for telemedicine visits).

The national 2015 Childhood Opportunity Index 2.0 was collected from 2020 ZIP code data (diversitydatakids.org). Risk status was categorized as follows: High risk-MOS-R < 20 or a HINE score of < 57 or >5 asymmetries, Moderate risk: MOS-R of 20-24 or a HINE score of 57-66, and Low risk: MOS-R >24 or a HINE >66. Developmental impairments were defined as any BSITD or DAYC-2 score < 80 ( < 10%) and/or CP.

Results: 487 infants had the GMA MOS-R (n=283) and/or the HINE (n=448) and were assessed with either the BSITD or DAYC-2 at 6-12 months corrected age. GMA videos and HINE assessments were obtained at a median of 53 weeks postmenstrual age (IQR: 53-55 wks). The BSITD and DAYC-2 were obtained at a median of 9 months CA (IQR: 8-10 months). Table 1 shows the associations between 3-5 month risk status, gestational age, zip code COI, developmental test results and CP. Compared to infants at Low risk, the odds of any delay or CP were increased in Moderate risk (OR: 1.91, 95% CI: 1.13-3.32) and High Risk (OR: 44.8; 95% CI: 20.43-98.25) infants. Odds of any delay or CP did not appreciably change when adjusted for gestational age category or Zip Code COI, which were not significant in a multivariable regression analysis).

Conclusion(s): Early detection screening at 3-5 months identified infants at increased risk for developmental delays and CP at 6-12 months. High risk infants had a nearly 90% rate of any delay or CP. These data support the use of early detection screening to identify infants who would benefit from early intervention therapy services.