Early markers for unilateral spastic cerebral palsy in premature infants

Christa Einspieler

This article has no abstract so we have provided the first paragraph of the full text.

In 1997, Heinz Prechtl and his group demonstrated that the assessment of spontaneous GMs, particularly at 3 months of age, is a reliable and valid tool to distinguish between infants who are at significant risk of developing neurological deficits and those who are not.¹ These results were based on a longitudinal study of 130 infants who displayed the whole spectrum of perinatal brain ultrasound findings. The GMs examined were the age-specific fidgety movements, which are small movements of the neck, trunk and limbs, of variable acceleration and in all directions (see Supplementary Movie 1 online). They are the predominant motor pattern in awake infants at 3–5 months of age.² Infants develop normally if these fidgety GMs are present and normal, even if their ultrasound findings indicate a disposition to later neurological deficits. On the other hand, if fidgety movements are absent, infants develop neurological deficits even if their ultrasound does not indicate a considerable risk.³ The value of fidgety GMs for the early prediction of CP is well documented (specificity 96%, sensitivity 95%; negative likelihood ratio 0.05, positive likelihood ratio >51).^{1, 2} It is of great relevance that Maurizio Romeo and colleagues present similar findings (specificity 94%, sensitivity 98%) in a study population seven times larger than that examined by Prechtl (903 preterm infants) and with a wide variety of neurological risks.

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