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AIM The aim of this study was to investigate the predictive value of a computer-based video analysis of the development of cerebral palsy (CP) in young infants. METHOD A prospective study of general movements used recordings from 30 high-risk infants (13 males, 17 females; mean gestational age 31wks, SD 6wks; range 23-42wks) between 10 and 15 weeks post term when fidgety movements should be present. Recordings were analysed using computer vision software. Movement variables, derived from differences between subsequent video frames, were used for quantitative analyses. CP status was reported at 5 years. RESULTS Thirteen infants developed CP (eight hemiparetic, four quadriparetic, one dyskinetic; seven ambulatory, three non-ambulatory, and three unknown function), of whom one had fidgety movements. Variability of the centroid of motion had a sensitivity of 85% and a specificity of 71% in identifying CP. By combining this with variables reflecting the amount of motion, specificity increased to 88%. Nine out of 10 children with CP, and for whom information about functional level was available, were correctly predicted with regard to ambulatory and non-ambulatory function. INTERPRETATION Prediction of CP can be provided by computer-based video analysis in young infants. The method may serve as an objective and feasible tool for early prediction of CP in high-risk infants.

Objective Absence of fidgety movements (FM) in high-risk infants is a strong marker for later cerebral palsy (CP). FMs can be classified by the General Movement Assessment (GMA), based on Gestalt perception of the infant's movement pattern. More objective movement analysis may be provided by computer-based technology. The aim of this study was to explore the feasibility of a computer-based video analysis of infants' spontaneous movements in classifying non-fidgety versus fidgety movements. Method GMA was performed from video material of the fidgety period in 82 term and preterm infants at low and high risks of developing CP. The same videos were analysed using the developed software called General Movement Toolbox (GMT) with visualisation of the infant's movements for qualitative analyses. Variables derived from the calculation of displacement of pixels from one video frame to the next were used for quantitative analyses. Results Visual representations from GMT showed easily recognisable patterns of FMs. Of the eight quantitative variables derived, the variability in displacement of a spatial centre of active pixels in the image had the highest sensitivity (81.5) and specificity (70.0) in classifying FMs. By setting triage thresholds at 90% sensitivity and specificity for FM, the need for further referral was reduced by 70%. Conclusion Video recordings can be used for qualitative and quantitative analyses of FMs provided by GMT. GMT is easy to implement in clinical practice, and may provide assistance in detecting infants without FMs.

Objective To investigate the feasibility and safety of skin-to-skin care after birth for moderately preterm infants. Design Prospective cohort study. Setting The study was conducted at the maternity wards and NICUs of three study sites in Norway. Participants Ninety preterm infants born vaginally with gestational ages of 32 weeks/0 days to 34 weeks/6 days. Methods Comparison of groups of preterm infants who received skin-to-skin care or conventional treatment in incubators after birth. Results Median gestational age and birth weight were similar in the two groups: 33 weeks/5 days versus 34 weeks/3 days ( p = .464) and 2,100 versus 2,010 g ( p = .519). There were no differences in the first body temperature ( p = .841) and blood glucose level ( p = .539) between the groups. Conclusion Early skin-to-skin contact in the delivery room for moderately preterm infants may be feasible and safe.

Background: Most studies on Prechtl's method of assessing General Movements (GMA) in young infants originate in Europe. Aim: To determine if motor behavior at an age of 3 months post term is associated with motor development at 12 months post age in VLBW infants in India. Methods: 243 VLBW infants (135 boys, 108 girls; median gestational age 31wks, range 26–39wks) were video-recorded at a median age of 11wks post term (range 9–16wks). Certified and experienced observers assessed the videos by the “Assessment of Motor Repertoire – 2–5 Months”. Fidgety movements (FMs) were classified as abnormal if absent, sporadic or exaggerated, and as normal if intermittently or continually present. The motor behaviour was evaluated by repertoire of co-existent other movements (age-adequacy) and concurrent motor repertoire. In addition, videos of 215 infants were analyzed by computer and the variability of the spatial center of motion (CSD) was calculated. The Peabody Developmental Motor Scales was used to assess motor development at 12 months. Results: Abnormal FMs, reduced age adequacy, and an abnormal concurrent motor repertoire were significantly associated with lower Gross Motor and Total Motor Quotient (GMQ, TMQ) scores (p < 0.05). The CSD was higher in children with TMQ scores

The general movement assessment (GMA) method is used to predict cerebral palsy (CP) in infants with high risk of developing neurological dysfunctions. Most of the work on GMA has been performed from the same group of researchers. The aim of this study was to demonstrate to what extent GMA predicted CP in our hands.A prospective study was performed using the Prechtl classification system for GMA in the fidgety period to predict later cerebral palsy. The study population consisted of 74 term and preterm infants at low and high risk of developing neurological dysfunction. The absence or presence of CP was reported at 23 months median-corrected age by the child's physician and the parents.The GMA identified all 10 infants that later were classified as having CP. GMA also identified all the infants that did not develop CP except for one infant with abnormal GMA and no CP. Three infants had uncertain CP status at follow-up. The sensitivity of GMA with regard to later CP was 100% with 95% CI (0.73, 1.00) and the specificity was 98% with 95% CI (0.91, 0.99) when the three uncertain cases were excluded.Our study indicates that the GMA used in a clinical setting strongly predicts the development of CP. The work supports the results of previous studies and contributes to the validation of GMA. The qualitative nature of this method may be a problem for inexperienced observers. Larger clinical studies are needed.

1 To characterize agonist-induced relaxation in femoral artery rings from young piglets, we compared the effect of a NOS-inhibitor N(omega)-nitro-L-arginine (L-NOARG), an NO-inactivator oxyhaemoglobin (HbO) and a soluble guanyl cyclase(sGC)-inhibitor 1H-[1,2,4]Oxadiazolo-[4,3,-alpha]quinoxalin-1-one (ODQ) on acetylcholine(ACh)-induced relaxation. The involvement of K(+) channel activation was studied on relaxations induced by ACh, the two NO donors sodium nitroprusside (SNP) and diethylamine (DEA) NONOate, and the cell membrane permeable guanosine 3'5' cyclic monophosphate (cGMP) analogue 8-Br-cGMP. 2 Full reversal of phenylephrine-mediated precontraction was induced by ACh (1 nM-1 microM) (pD(2) 8.2+/-0.01 and R(max) 98.7+/-0.3%). L-NOARG (100 microM) partly inhibited relaxation (pD(2) 7.4+/-0.02 and R(max) 49.6+/-0.8%). The L-NOARG/indomethacin(IM)-resistant response displayed characteristics typical for endothelium-derived hyperpolarizing factor (EDHF), being sensitive to a combination of the K(+) channel blockers charybdotoxin (CTX) (0.1 microM) and apamin (0.3 microM). 3 ODQ (10 microM) abolished relaxations induced by ACh and SNP. L-NOARG/IM-resistant relaxations to ACh were abolished by HbO (20 microM). 4 Ouabain (1 microM) significantly inhibited ACh-induced L-NOARG/IM-resistant relaxations and relaxations induced by SNP (10 microM) and 8-Br-cGMP (0.1 mM). A combination of ouabain and Ba(2+) (30 microM) almost abolished L-NOARG/IM-resistant ACh-induced relaxation (R(max) 7.7+/-2.5% vs 23.4+/-6.4%, with and without Ba(2+), respectively, P

Background A computer-based video analysis has recently been presented for quantitative assessment of general movements (GMs). This method's test–retest reliability, however, has not yet been evaluated. Aims The aim of the current study was to evaluate the test–retest reliability of computer-based video analysis of GMs, and to explore the association between computer-based video analysis and the temporal organization of fidgety movements (FMs). Study design Test–retest reliability study. Subjects 75 healthy, term-born infants were recorded twice the same day during the FMs period using a standardized video set-up. Outcome measures The computer-based movement variables "quantity of motion mean" (Qmean), "quantity of motion standard deviation" (Q SD ) and "centroid of motion standard deviation" (C SD ) were analyzed, reflecting the amount of motion and the variability of the spatial center of motion of the infant, respectively. In addition, the association between the variable CSD and the temporal organization of FMs was explored. Intraclass correlation coefficients (ICC 1.1 and ICC 3.1) were calculated to assess test–retest reliability. Results The ICC values for the variables C SD , Q mean and Q SD were 0.80, 0.80 and 0.86 for ICC (1.1), respectively; and 0.80, 0.86 and 0.90 for ICC (3.1), respectively. There were significantly lower C SD values in the recordings with continual FMs compared to the recordings with intermittent FMs ( p Conclusion This study showed high test–retest reliability of computer-based video analysis of GMs, and a significant association between our computer-based video analysis and the temporal organization of FMs.

A non-dysmorphic term boy presented with inspiratory stridor shortly following delivery. Following clinical examination and thoracic x-ray, no external features or other clinical findings revealed any obvious explanation. Laryngomalacia was suspected. A combined rhinopharyngo—oropharyngo—and laryngoscopy revealed a cystic mass stretching from nasopharynx, to oropharynx and distally beyond the postcricoid structures, filling out 2/3 of the oropharyngeal space. The neck mass increased in size and became externally …

To compare early motor repertoire between extremely preterm and term-born infants. An association between the motor repertoire and gestational age and birth weight was explored in extremely preterm infants without severe ultrasound abnormalities.In a multicentre study, the early motor repertoire of 82 infants born extremely preterm (ELGAN:28 weeks) and/or with extremely low birth weight (ELBW:1000 g) and 87 term-born infants were assessed by the "Assessment of Motor Repertoire - 2 to 5 Months" (AMR) which is part of Prechtl's "General Movement Assessment", at 12 weeks post-term age. Fidgety movements were classified as normal if present and abnormal if absent, sporadic or exaggerated. Concurrent motor repertoire was classified as normal if smooth and fluent and abnormal if monotonous, stiff, jerky and/or predominantly fast or slow.Eight-teen ELBW/ELGAN infants had abnormal fidgety movements (8 absent, 7 sporadic and 3 exaggerated fidgety movements) compared with 2 control infants (OR:12.0; 95%CI:2.7-53.4) and 46 ELBW/ELGAN infants had abnormal concurrent motor repertoire compared with 17 control infants (OR:5.3; 95%CI:2.6-10.5). Almost all detailed aspects of the AMR differed between the groups. Results were the same when three infants with severe ultrasound abnormalities were excluded. In the remaining ELBW/ELGAN infants, there was no association between motor repertoire and gestational age or birth weight.ELBW/ELGAN infants had poorer quality of early motor repertoire than term-born infants.The findings were not explained by severe abnormalities on neonatal ultrasound scans and were not correlated to the degree of prematurity. The consequences of these abnormal movement patterns remain to be seen in future follow-up studies.

Mechanisms mediating endothelium-dependent vasodilation were investigated in femoral artery rings from

Postnatal Changes in Mechanisms Mediating Acetylcholine-Induced Relaxation in Piglet Femoral Arteries 1

This study evaluates the role of postterm age at assessment and the use of one or two video recordings for the detection of fidgety movements (FMs) and prediction of cerebral palsy (CP) using computer vision software. Recordings between 9 and 17 weeks postterm age from 52 preterm and term infants (24 boys, 28 girls; 26 born preterm) were used. Recordings were analyzed using computer vision software. Movement variables, derived from differences between subsequent video frames, were used for quantitative analysis. Sensitivities, specificities, and area under curve were estimated for the first and second recording, or a mean of both. FMs were classified based on the Prechtl approach of general movement assessment. CP status was reported at 2 years. Nine children developed CP of whom all recordings had absent FMs. The mean variability of the centroid of motion (CSD) from two recordings was more accurate than using only one recording, and identified all children who were diagnosed with CP at 2 years. Age at assessment did not influence the detection of FMs or prediction of CP. The accuracy of computer vision techniques in identifying FMs and predicting CP based on two recordings should be confirmed in future studies.

The aim of this study was to investigate the predictive value of a computer-based video analysis of the development of cerebral palsy (CP) in young infants.A prospective study of general movements used recordings from 30 high-risk infants (13 males, 17 females; mean gestational age 31wks, SD 6wks; range 23-42wks) between 10 and 15 weeks post term when fidgety movements should be present. Recordings were analysed using computer vision software. Movement variables, derived from differences between subsequent video frames, were used for quantitative analyses. CP status was reported at 5 years.Thirteen infants developed CP (eight hemiparetic, four quadriparetic, one dyskinetic; seven ambulatory, three non-ambulatory, and three unknown function), of whom one had fidgety movements. Variability of the centroid of motion had a sensitivity of 85% and a specificity of 71% in identifying CP. By combining this with variables reflecting the amount of motion, specificity increased to 88%. Nine out of 10 children with CP, and for whom information about functional level was available, were correctly predicted with regard to ambulatory and non-ambulatory function.Prediction of CP can be provided by computer-based video analysis in young infants. The method may serve as an objective and feasible tool for early prediction of CP in high-risk infants.

To assess if growth restricted (small for gestational age, SGA) extremely preterm infants have excess neonatal mortality and morbidity.This was a cohort study of all infants born alive at 22-27 weeks' post menstrual age in Norway during 1999-2000. Outcomes were compared between those who were SGA, defined as a birth weight less than the fifth percentile for post menstrual age, and those who had weights at or above the fifth percentile.Of 365 infants with a post menstrual age of28 weeks, 31 (8%) were SGA. Among infants with a post menstrual age of28 weeks, only chronic lung disease was associated with SGA status (OR 2.7, 95% CI 1.0 to 7.2). SGA infants with a post menstrual age of 26-27 weeks had excess neonatal mortality (OR 3.8, 95% CI 1.3 to 11), chronic lung disease and a significantly higher mean number of days (age) before tolerating full enteral nutrition. SGA infants with a post menstrual age of 22-25 weeks had an excess risk of necrotising enterocolitis.Extremely preterm SGA infants had excess neonatal mortality and morbidity in terms of necrotising enterocolitis and chronic lung disease.

Purpose: To investigate whether iodinated radiographic contrast media (IRCM) mimic the hyperpolarizing and vasodilator effects of K+ by comparing the vasodilator effect of a transient rise in extracellular K+ with that of the IRCM iohexol. Material and Methods: Immersed rabbit central ear arterial rings with and without endothelium and pre-contracted with phenylephrine (PE) were used to investigate the dependency of the endothelium in K+-induced vasodilatation. Perfused rabbit central ear arteries, pre-contracted with PE, were used to study the effects of bolus administrations of the IRCM iohexol or KCl on arterial tone under conditions that mimic those employed during clinical arteriography. Results: A small rise in K+ caused an endothelium-independent and ouabain-sensitive relaxation of PE-constricted rabbit central ear artery rings. The relaxation was not changed in the presence of barium. The IRCM iohexol and KCl, injected as boluses into perfused PE-constricted rabbit ear arteries, caused transient decreases in perfusion pressure. Iohexol- and K+-induced pressure decreases were significantly reduced in the presence of 10 µM ouabain alone or in combination with 30 µM barium. Neither iohexol- nor K+-induced pressure decrease was significantly changed in the presence of barium alone compared to controls. Conclusion: The vasodilator effect of IRCM mimics the vasodilator effect seen upon small increase in extracellular K+. Under the experimental conditions employed in the present study, a considerable part of the IRCM-induced vasodilatation appears to be due to activation of Na+/K+-ATPase in the smooth muscle cells.

Computer Based Assessment of General Movements in Young Infants using One or Two Video Recordings

In the pulmonary and mesenteric circulation, NO is known to be an important vasodilator during the period of postnatal transitional circulation. Little is known about the contribution of endothelium-derived hyperpolarizing factor(EDHF). We previously demonstrated that the NOS-inhibitor L-NMMA had little effect on ACh-mediated relaxation in femoral artery rings from newborn piglets, whereas it significantly inhibited relaxation in rings from 2 week old piglets. We therefore hypothesized that EDHF is more important than NO in mediating ACh-induced relaxation in newborn arteries, and that the relative importance of NO increases with age.