Prematüre Bebeklerin Erken Spontan Motor Hareketlerinin Detaylı Analizi ve Nörogelişimsel Sonuçlarının Değerlendirilmesi

Abstract

Porsnok, D., The Detailed Analysis of Early Spontaneous Motor Movements in Premature Infants and Evaluation of Neurodevelopmental Outcomes, Hacettepe University, Graduate School of Health Sciences, Physical Therapy and Rehabilitation, Doctor of Philosophy Thesis, Ankara, 2023. The aim of this study was; (i) to longitudinally compare the motor repertoire by analysing the detailed motor repertoires of preterm infants and their neurotypical term peers, according to their gestational age (GA), within the scope of general movements (GMs) assessment, (ii) to investigate the relationship between detailed motor repertoires at preterm/term age, 3-5 months and their neurodevelopmental outcomes at 1 year of corrected age (CA) and (iii) to compare the neurodevelopmental outcomes of infants according to their GA at 1 year of CA. The 132 infants included in the study were divided into 3 groups: extremely-very preterm infants (<32 weeks GA; n=38), moderate to late preterm infants (32-36 weeks GA; n=51) and term infants (37-41 weeks; n=43). The preterm infant's early motor repertoire were assessed at preterm/term period (35-41 weeks), at early postterm period (42-45 weeks) and at fidgety period (49-60 weeks) and term infant's at early postterm period (42-45 weeks) and at fidgety period (49-60 weeks). General Movements Optimality Score (GMOS) and Motor Optimality Score form-Revised (MOS-R) were used for the assessment of early motor repertoire. In addition, HINE and Bayley-III scales were applied to all infants at 1 year of CA. There was no difference between the GMOS and GMOS subcategory scores between extremely-very preterm infants and moderate to late preterm infants in the preterm/term period (p>0.05). The GMOS score of term infants was higher than extremely-very preterm infants at postterm period (p<0.001). GMOS and MOS-R centile ranks of preterm infants increased over time from preterm/term period to fidgety period and the improvement was higher in moderate to late preterm infants than extremely-very preterm infants (p=0.016). GMOS and MOS-R centile ranks of term infants also increased over time and there was a difference in the rate of increase in motor repertoire between the three groups (p<0.001). There was difference between the groups of premature infants and term infants in terms of HINE scores (p<0.001) and Bayley-III cognitive (p<0.001), language (p=0.001) and motor (p<0.001) domains at 1 year of CA. Both HINE and Bayley-III scores of extremely-very preterm infants were lower than the other two groups. In the extremely-very preterm group, there was a significant correlation between GMOS and HINE scores in both preterm/term and early postterm periods (except neck and trunk scores). Similarly, there was a correlation between GMOS and all domains of Bayley-III in both preterm/term and early postterm periods (except neck and trunk score) in extremely-very preterm infants. In conclusion; the motor performance of term infants was better than that of extremely-very preterm infants in both early postterm and fidgety periods. The early motor repertoire performances of both preterm and term infants improved progressively over time. The rate of improvement over time was higher in moderate to late preterm infants than extremely-very preterm infants. It is suggested that abnormal GMs trajectories (PR-PR, CS-CS) in preterm infants may be a predictor of poor neurodevelopment and infants should be referred to targeted early intervention programme as soon as these patterns are detected.