Objective:

We aimed to determine if Prechtl’s general movement assessment (GMA) could help target the use of magnetic resonance imaging (MRI) in the neonatal intensive care unit (NICU) to detect infants with neuroimaging abnormalities not detected by cranial ultrasound (CUS) alone.

Background:

Prechtl’s GMA is a bedside evaluation performed to identify infants at high-risk for neurological and motor disorders such as cerebral palsy (CP). Cramped synchronized (CS) GMA at writhing age has been associated with poor neuromotor outcomes. However, no clinical practice guideline exists to recommend routine use of term-equivalent MRI in infants with CS GMAs.

Design/Methods:

We retrospectively reviewed neuroimaging reports from pediatric neuroradiologists of all infants who had CS GMA between 36 and 44 weeks post-menstrual age at two level III and three level IV NICUs. All three sites used standard protocols for preterm neuroimaging with at least one CUS in the first week after birth and another near 30 weeks corrected gestational age. If an MRI was obtained (due to clinical suspicion for intracranial abnormality, abnormal CUS findings, or CS GMA) the reason for performing the MRI was recorded.

Results:

144 infants had CS GMA, and of these, only 19 did not receive neuroimaging. Initial neuroimaging demonstrated abnormal (mild and severe) findings in 64.5% and clinically significant in 45.6%. When MRI was performed secondarily, agreement between the two types of imaging occurred most of the time. A higher level of insult was present in 20.7% of those receiving a secondary MRI. The frequency of clinically significant abnormal findings on final determination was 48.8%. In 14 cases, secondary MRI was performed in response to GMA CS pattern only; in this case, MRI was abnormal in 11 (76.8%) cases.

Conclusions:

These results suggest that infants with CS GMA at writhing age may represent a population with a high-likelihood of clinically significant abnormal neuroimaging findings.