193 - Feasibility and reliability of evaluating Prechtl’s Assessment of General Movements (GMA) for preterm infants through telemedicine

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 193
Publication Number: 193.142

Natalie H. Chan, UCSF, San Francisco, CA, United States; Ziad Alhassen, CHOC Children's Hospital of Orange County, Irvine, CA, United States; Kristin R. Hoffman, University of California, Davis, School of Medicine, Sacramento, CA, United States; Catherine A. Rottkamp, University of California Davis Children's Hospital, Sacramento, CA, United States

Presenting Author(s)

Natalie H. Chan, MD, MPH (she/her/hers)

Assistant Professor, Department of Pediatrics Neonatologist, Director of ICN Follow-Up Program
UCSF (University of California, San Francisco)
San Francisco, California, United States

Background:

The GMA is used in early infancy to identify infants at high risk of cerebral palsy (CP) and neurodevelopmental impairment. GMA and term-corrected MRI in combination is the most sensitive and specific for early identification of CP and they can be used for infants less than 5 months of age. GMA on its own has been shown to be more sensitive than MRI alone (GMA sensitivity 98%, MRI 86-89% sensitivity). The gold-standard method of evaluating GMA is review of video recordings of infant GMs, often requiring in person visits to acquire. GMA in real-time via telemedicine may increase accessibility to timely identification of CP.

Objective:

To compare the inter-rater reliability of real-time scoring of GMA during a telemedicine visit versus scoring through a video recording of the telemedicine visit.

Design/Methods:

GMA of infants < 32 weeks gestation or with birth weight < 1500 grams were evaluated via a telemedicine platform during 3 time periods: preterm (32-34w post-menstrual age (PMA)), term (40-44w PMA), and fidgety (11-14w post-term). Infants were either evaluated while in the NICU or in their home environments. Fidgety GMA results are categorized as: normal, absent or abnormal. Since absence of fidgety GMs is the most predictive indicator of CP, the primary endpoint was to compare the inter-rater reliability (kappa statistic) of real-time vs. video recording GMA at the fidgety stage. Three GMA trained clinicians evaluated GMs of infants. Each infant was randomly assigned the same clinician for their real-time GMA, and another for their video-recording GMA.

Results:

67 infants of 116 eligible infants were recruited. 45 infants had fidgety period videos analyzed for the primary outcome. Mean age at video assessments were 34w 4d (SD 1w2d) during the preterm writhing period, 43w4d PMA, (SD 1w6d) during the term writing period and 15w1d post-term (SD 1w2d) during the fidgety period. Inter-rater reliability was fair (kappa = 0.35) for the fidgety period, with 87% agreement between real-time versus video-review of assessments. The inter-rater reliability was poor for both term (kappa = 0.03, 48% agreement) and preterm (kappa = 0.07, 47% agreement) writhing periods.

Conclusion(s):

Acquisition of GMA videos through a real-time telemedicine platform was feasible and real-time versus video-recording assessment of GMs had fair inter-rater reliability. Use of telemedicine for GMA can increase access for early identification of CP for high-risk infants.