P1.232: Bronchopulmonary Dysplasia is an independent predictor for abnormal General Movements Assessment in the NICU

Background: The Prechtl General Movement Assessment (GMA) is a visual diagnostic tool used to identify infants at higher risk of neurodevelopmental delays and cerebral palsy. Early identification of at-risk infants allows for timely initiation of intervention services aimed at improving functional outcomes. Prior to GMA implementation, the standard at the Children’s Hospital of the King’s Daughters for identifying high risk infants included screening with serial head ultrasounds and obtaining MRIs for infants with abnormal neurologic exams. The goal of this study is to incorporate GMA as an additional tool to identify infants at high risk for neurological impairment.

Methods: Starting in 2024, CHKD began performing GMA on all babies admitted to the Level 4 NICU. Under approved protocol 24-10-NH-0260, details about GMA testing and risk factors were collected including gestational age (GA), birthweight (BW), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), hypoxic-ischemic encephalopathy (HIE), seizures, and bronchopulmonary dysplasia (BPD). Available neuroimaging data was reviewed. GMA testing was conducted by two certified physical therapists and data was compiled in collaboration with a multidisciplinary team of developmental care specialists. Movements were characterized into- normal general movements, poor repertoire, cramped-synchronized, or chaotic. Univariate and multivariate regression analyses were performed to correlate risk factors with GMA results.

Results: A total of 157 infants were included in the study. 13 medically unstable infants were excluded from preterm writhing GMA. In univariate analysis, the likelihood of normal movements was significantly higher for infants with GA >28 weeks when compared to < 28 weeks (OR=2.41, 95% CI (1.02, 5.84), p=0.031). Likelihood of normal movements was significantly lower for participants with seizure activity (p=0.02) and HIE (p=0.012). GA < 28 weeks, HIE, and seizure activity were associated with increased likelihood of poor repertoire. In separate multivariate analysis (for BW and GA) using logistic regression, BPD was a significant risk factor for abnormal GMA after controlling for confounders such as sex, IVH, HIE, NEC, and abnormal neuroimaging. The likelihood of normal movements was significantly lower among subjects with BPD, and that of poor repertoire was significantly higher in BPD (Tables 1 and 2).

Conclusion: Institution of GMA as standard practice in the CHKD NICU is aiding in identifying potential risk factors for abnormal GMA such as BPD. Our study was limited by a small sample size and lack of control group. Longitudinal data collection is ongoing. Future directions include correlating GMA results with long-term follow up over the first 3 years of life, and comparing results to other assessments such as Bayley IV and Capute scales. Earlier institution of therapies as a result of GMA evaluations may aid in improving long-term functional outcomes in infants at risk for neurodevelopmental impairment.