“Fidgety-like movements” in infants born extremely preterm and their relation to later neurodevelopmental outcome

BACKGROUND: A variant of spontaneous movements "fidgety-like movements" has been described, but its prevalence and clinical relevance remain unclear. AIM: To describe the prevalence of "fidgety-like movements" at 3-5 months corrected age (CA), its relation to major cerebral lesions, and neurodevelopmental outcome in children born extremely preterm (EPT; <28 weeks gestation). METHOD: A retrospective re-analysis was conducted using three General Movement Assessment datasets, including Motor Optimality Score-Revised (MOS-R) at 3-5 months CA, in 402 infants born EPT from cohorts in the Netherlands, Sweden and Australia. Follow-up age ranged 1-8 years. Neurodevelopmental outcomes were assessed using standardized assessments and ICD-10, and classified as typical or adverse. RESULTS: Twenty-six of 402 infants (7%; range 5-8%) (mean gestational age ± SD, 25.1 ± 1.4 weeks; birth weight 780.1 ± 202.1 g) showed "fidgety-like movements". Median (IQR) MOS-R was 22 (21-24). Eighteen (69%) were boys, 18 (69%) had bronchopulmonary dysplasia and two (8%) had severe brain lesions. Follow-up data were available for 25 children (96%): 12 (48%) had typical and 13 (52%) adverse outcomes. Of those with adverse outcomes, most were motor delay (n = 6, 24%), language delay (n = 5, 20%) and ADHD (n = 4, 16%) or combined, with only one case of CP (4%). Fifty-four percent of children had MOS-R < 23 (below cut-off for high risk of NDD). CONCLUSION: The rate of "fidgety-like movements" was 7% in infants born EPT. Only one infant developed CP; however, more than half of infants with "fidgety-like movements" had adverse outcomes and reduced MOS-R scores highlighting need for careful follow-up.