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Fabrizio Ferrari, MD; Giovanni Cioni, MD; Christa Einspieler, PhD; M. Federica Roversi, MD; Arend F. Bos, MD, PhD; Paola B. Paolicelli, MD; Andrea Ranzi, PhD; Heinz F. R. Prechtl, MD, DPhil, FRCOG(Hon)

Arch Pediatr Adolesc Med. 2002;156(5):460-467.

Objective  To ascertain whether specific abnormalities (ie, cramped synchronized general movements [GMs]) can predict cerebral palsy and the severity of later motor impairment in preterm infants affected by brain lesions.

Design  Traditional neurological examination was performed, and GMs were serially videotaped and blindly observed for 84 preterm infants with ultrasound abnormalities from birth until 56 to 60 weeks' postmenstrual age. The developmental course of GM abnormalities was compared with brain ultrasound findings alone and with findings from neurological examination, in relation to the patient's outcome at age 2 to 3 years.

Results  Infants with consistent or predominant (33 cases) cramped synchronized GMs developed cerebral palsy. The earlier cramped synchronized GMs were observed, the worse was the neurological outcome. Transient cramped synchronized character GMs (8 cases) were followed by mild cerebral palsy (fidgety movements were absent) or normal development (fidgety movements were present). Consistently normal GMs (13 cases) and poor repertoire GMs (30 cases) either lead to normal outcomes (84%) or cerebral palsy with mild motor impairment (16%). Observation of GMs was 100% sensitive, and the specificity of the cramped synchronized GMs was 92.5% to 100% throughout the age range, which is much higher than the specificity of neurological examination.

Conclusions  Consistent and predominant cramped synchronized GMs specifically predict cerebral palsy. The earlier this characteristic appears, the worse is the later impairment.

From the Institute of Paediatrics and Neonatal Medicine, University of Modena, Italy (Drs Ferrari, Roversi, and Ranzi); the Institute of Developmental Neurology, Psychiatry, and Educational Psychology, University of Pisa, and the Stella Maris Foundation, Calambrone, Pisa, Italy (Drs Cioni and Paolicelli); the Department of Physiology, University of Graz, Austria (Drs Einspieler and Prechtl); and the Department of Paediatrics, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands (Dr Bos).

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