Karin Nielsen-Saines, MD, MPH Professor of Clinical Pediatrics Division of Pediatric Infectious Diseases  David Geffen School of Medicine at UCLA

Zika: Simple General Movement Assessment Tool Can Predict Babies at Risk of Developmental Problems

MedicalResearch.com Interview with:

Karin Nielsen-Saines, MD, MPH Professor of Clinical Pediatrics Division of Pediatric Infectious Diseases  David Geffen School of Medicine at UCLA

Dr. Nielsen

Karin Nielsen-Saines, MD, MPH
Professor of Clinical Pediatrics
Division of Pediatric Infectious Diseases
David Geffen School of Medicine at UCLA

MedicalResearch.com: What is the background for this study?

Response: Our study used a very simple evaluation called GMA (General Movement Assessment tool) which checks baby movements at approximately 3 to 5 months of age.

We examined 111 babies exposed to maternal illness during the Zika epidemic in Brazil and 333 control babies without this exposure by GMA at 3 months  and then tested them through standard neurodevelopmental tests at the age of 12 months.

We found that this simple evaluation, which consists of filming a baby lying down on their back for one minute and studying their movements worked extremely well in predicting which babies would or would not have future problems in their neurodevelopment. The study advances knowledge in the area because a simple one minute video of a baby can predict neurodevelopment, something that is extremely hard to determine in young babies.  This is true even in places where sophisticated brain scans are available. By identifying which babies are at risk of developmental problems early on, professionals can rapidly refer these babies to  stimulation programs when they are very young, which increases their chances of having better outcomes. Because the brains of young children respond much better  to stimulation, the timing of interventions to improve their development is very important, that is why they need to be identified early.

MedicalResearch.com: What are the main findings? 

Response In the study, none of the infants with microcephaly (35 babies) had normal infant movements by GMA and all of them had altered neurodevelopment. Evaluation of less extreme cases of 56 babies exposed to Zika who did not have microcephaly showed that 10 of these babies (18%) also had abnormal development. 96% of babies who had normal movements by GMA also had normal neurodevelopment (specificity). Seven of 10 children with abnormal development (70%) were correctly identified by GMA (sensitivity).

The study advances knowledge in the area because a simple one minute video of a baby can predict neurodevelopment, something that is extremely hard to determine in young babies.  This is true even in places where sophisticated brain scans are available. By identifying which babies are at risk of developmental problems early on, professionals can rapidly refer these babies to  stimulation programs when they are very young, which increases their chances of having better outcomes. Because the brains of young children respond much better  to stimulation, the timing of interventions to improve their development is very important, that is why they need to be identified early.  For all these reasons, the findings are very relevant to global health, as this is a very simple tool that can be performed anywhere, even in the absence of sophisticated scans and medical centers. This tool helps improve infant outcomes by being able to identify those at risk of poor development, so that the infants with the highest risk can be referred to specialized programs, which also improves health care delivery.

MedicalResearch.com: What should readers take away from your report?

Response: A large proportion of babies with antenatal Zika virus exposure (79%) had normal movements and normal development at 12 months. Nevertheless a relatively large proportion of children (17%), did not develop normally, even in the absence of microcephaly.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: GMA should be incorporated into future assessments of children with antenatal arboviral exposure to help determine who would benefit from early intervention programs to improve neurodevelopment. It is important to follow all children with congenital exposures to infectious pathogens to determine developmental status. Future studies should evaluate the GMA tool in other perinatal infections.   

No disclosures.

Citation:

Einspieler C, Utsch F, Brasil P, et al. Association of Infants Exposed to Prenatal Zika Virus Infection With Their Clinical, Neurologic, and Developmental Status Evaluated via the General Movement Assessment Tool. JAMA Netw Open. 2019;2(1):e187235. doi:10.1001/jamanetworkopen.2018.7235

Jan 21, 2019 @ 2:56 am

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