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Introduction: Infants born very preterm (VPT, <32 weeks' gestation) are at increased risk for neurodevelopmental impairments including motor, cognitive and behavioural delay. Parents of infants born VPT also have poorer mental health outcomes compared with parents of infants born at term.We have developed an intervention programme called TEDI-Prem (Telehealth for Early Developmental Intervention in babies born very preterm) based on previous research. TEDI-Prem aims to improve neurodevelopmental outcomes and parental well-being in children born VPT. Here we present the protocol outlining a multicentre, pragmatic, parallel-group, randomised controlled trial to determine the efficacy of TEDI-Prem plus usual care, compared with usual care alone., Methods and Analysis: We will recruit 466 VPT infants from the neonatal units of five hospitals in Victoria, Australia. Participants will be randomised, stratified by site of recruitment and multiple births, to TEDI-Prem plus usual care or usual care alone. The TEDI-Prem intervention programme involves 13 sessions across three phases. Phase 1 commences in the neonatal unit with four face-to-face sessions with parent/s and a physiotherapist/occupational therapist. Once discharged from the hospital, sessions across phases 2 and 3 (six and three sessions, respectively) continue via telehealth until infants are 12 months' corrected age (CA).The primary outcome is the Bayley Scales of Infant and Toddler Development-fourth edition (Bayley-4) Motor Composite Score at 12 months' CA. Secondary outcomes address other neurodevelopmental domains (Bayley-4 cognitive and language composite score; Infant Toddler Social Emotional Assessment), parental mental health (Depression Anxiety and Stress Scale 21), parent-child interaction (Emotional Availability Scale) and programme cost-effectiveness which encompasses parent quality of life (Short-Form Six-Dimension Quality of Life) and child quality of life (EuroQol Toddler and Infant Populations measure) at 12 and 24 months' CA.Mean differences between groups will be examined using linear regression for continuous outcomes and logistic regression for binary outcomes. All models will be fitted via generalised estimating equations to account for multiple births and adjusted for the hospital sites., Ethics and Dissemination: This trial has Royal Children's Hospital Human Research and Ethics Committee approval (HREC/67604/RCHM-2020) with specific site approval for all participating sites. Findings will be disseminated through peer-reviewed publications, conference presentations, digital and print media and to participants., Trial Egistration Number: This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000364875)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Over the first few months after birth, the typical emergence of spontaneous, fidgety general movements is associated with later developmental outcomes. In contrast, the absence of fidgety movements is a core feature of several neurodevelopmental and cognitive disorders. Currently, manual assessment of early infant movement patterns is time consuming and labour intensive, limiting its wider use. Recent advances in computer vision and deep learning have led to the emergence of pose estimation techniques, computational methods designed to locate and track body points from video without specialised equipment or markers, for movement tracking. In this study, we use automated markerless tracking of infant body parts to build statistical models of early movements. Using a dataset of infant movement videos (n = 486) from 330 infants we demonstrate that infant movement can be modelled as a sequence of eight motor states using autoregressive, state-space models. Each, motor state Is characterised by specific body part movements, the expression of which varies with age and differs in infants at high-risk of poor neurodevelopmental outcome., Competing Interests: Declarations Competing interests A.S. is a tutor with the General Movements Trust. All other authors have no conflicts of interest to declare., (© 2024. The Author(s).)

Objective: To describe the implementation of the international guidelines for the early diagnosis of cerebral palsy (CP) and engagement in the screening process in an Australian cohort of infants with neonatal risk factors for CP., Study Design: Prospective cohort study of infants with neonatal risk factors recruited at <6 months corrected age from 11 sites in the states of Victoria, New South Wales, and Queensland, Australia. First, we implemented a multimodal knowledge translation strategy including barrier identification, technology integration, and special interest groups. Screening was implemented as follows: infants with clinical indications for neuroimaging underwent magnetic resonance imaging and/or cranial ultrasound. The Prechtl General Movements Assessment (GMA) was recorded clinically or using an app (Baby Moves). Infants with absent or abnormal fidgety movements on GMA videos were offered further assessment using the Hammersmith Infant Neurological Examination (HINE). Infants with atypical findings on 2/3 assessments met criteria for high risk of CP., Results: Of the 597 infants (56% male) recruited, 95% (n = 565) received neuroimaging, 90% (n = 537) had scorable GMA videos (2% unscorable/8% no video), and 25% (n = 149) HINE. Overall, 19% of the cohort (n = 114/597) met criteria for high risk of CP, 57% (340/597) had at least 2 normal assessments (of neuroimaging, GMA or HINE), and 24% (n = 143/597) had insufficient assessments., Conclusions: Early CP screening was implemented across participating sites using a multimodal knowledge translation strategy. Although the COVID-19 pandemic affected recruitment rates, there was high engagement in the screening process. Reasons for engagement in early screening from parents and clinicians warrant further contextualization and investigation., Competing Interests: Declaration of Competing Interest This work was supported by the National Health and Medical Research Council Partnership grant AP1152800. Training on GMA and HINE and implementation of the QEDIN network is funded by the NHMRCCentre of Research Excellence the Australian-CP-Clinical Trials Network (NHMRC1078851) and for the QLD Early Detection and Early Intervention Network by QLD Department of Innovation Advance QLD Program16-103. RB is supported by an NHMRC Investigator grant (NHMRC1105038). A.J.S. and C.M. are tutors with the General Movements Trust. A.J.S. is on the editorial board of the Journal of Pediatrics. The other authors declare no conflicts of interest., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Cerebral palsy (CP) is the most common cause of physical disability during childhood, occurring at a rate of 2.1 per 1000 live births. Early diagnosis is key to improving functional outcomes for children with CP. The General Movements (GMs) Assessment has high predictive validity for the detection of CP and is routinely used in high-risk infants but only 50% of infants with CP have overt risk factors when they are born. The implementation of CP screening programs represents an important endeavour, but feasibility is limited by access to trained GMs assessors. To facilitate progress towards this goal, we report a deep-learning framework for automating the GMs Assessment. We acquired 503 videos captured by parents and caregivers at home of infants aged between 12- and 18-weeks term-corrected age using a dedicated smartphone app. Using a deep learning algorithm, we automatically labelled and tracked 18 key body points in each video. We designed a custom pipeline to adjust for camera movement and infant size and trained a second machine learning algorithm to predict GMs classification from body point movement. Our automated body point labelling approach achieved human-level accuracy (mean ± SD error of 3.7 ± 5.2% of infant length) compared to gold-standard human annotation. Using body point tracking data, our prediction model achieved a cross-validated area under the curve (mean ± S.D.) of 0.80 ± 0.08 in unseen test data for predicting expert GMs classification with a sensitivity of 76% ± 15% for abnormal GMs and a negative predictive value of 94% ± 3%. This work highlights the potential for automated GMs screening programs to detect abnormal movements in infants as early as three months term-corrected age using digital technologies., Competing Interests: Alicia Spittle is a tutor with the General Movements Trust. All other authors have no conflicts of interest to declare., (Copyright: © 2024 Passmore et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: Parents of preterm or sick infants are at increased risk of mental health problems. The financial stress associated with an infant's prolonged hospital stay can have an additional negative effect on families' wellbeing and child development. This study explores parent use of Australian paid parental leave (PPL) and the financial impact of having an infant requiring neonatal care., Methods: Retrospective, cross-sectional, online survey study conducted from November 2020 to February 2021. Participants were parents of babies born from 1 January 2013, admitted to a neonatal intensive care unit or special care nursery in Australia. The survey explored use of Australian Government and private sector PPL, and financial stress. Parent-reported anxiety and depression were measured using the EuroQol Group 5D-5L Anxiety and Stress Subscale., Results: Two hundred and thirty-one parents responded of which 93% had a preterm infant. Seventy-three percent of infants were hospitalised for more than 1 month, and 34% were readmitted to hospital within the first year following discharge home. Eighty-three percent of parents reported moderate, severe or extreme levels of anxiety or depression. Seventy-six percent reported that having a child in hospital had a moderate-very large financial impact on their family. Parents identified main costs to be travel, food, inability to work and direct medical costs., Conclusions: Having an infant born preterm or sick has significant emotional and financial implications for families. The current Australian Government PPL scheme does not adequately support parents of preterm or sick infants, and a change is urgently needed to improve outcomes for this vulnerable population., (© 2022 The Authors. Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

The authors of this study evaluated infant and parent outcomes at 12 and 24 months after a clinician-supported, web-based early intervention for preterm infants., Objective: To examine the efficacy of a clinician-supported, web-based intervention delivered over the first year after birth compared with standard care in children born after <34 weeks' gestation, on child development at 24 months corrected age (CA), parental mental health, and the parent-child relationship at 24 months., Methods: We randomly allocated 103 preterm infants to clinician-supported, web-based intervention (n = 50) or standard care control (n = 53) groups. At 24 months CA, child cognitive, language, motor, social-emotional development, and the parent-child relationship were assessed. Parental mental health and quality of life were assessed at 12 and 24 months CA., Results: At 24 months, child development, maternal mental health, and maternal quality of life were similar for the intervention and control groups. There was some evidence that mothers in the intervention group had lower odds of being in the elevated category for depression at 12 months (odds ratio: 0.19; 95% confidence interval [CI]: 0.04-0.90; P = .04). Scores were higher in the intervention group for child responsiveness (mean difference: 0.57; 95% CI: 0.03-1.11; P = .04), child involvement (mean difference: 0.61; 95% CI: 0.09-1.13; P = .02), and maternal structuring (mean difference: 0.72; 95% CI: 0.22-1.21; P = .01) during the parent-infant interaction at 24 months., Conclusions: This study provides preliminary evidence that a clinician-supported, web-based early intervention program for preterm infants had a positive effect on the parent-child relationship and maternal mental health immediately after the intervention but potentially little effect on child development., (Copyright © 2022 by the American Academy of Pediatrics.)

Background: Infants born extremely preterm (EP, <28-week gestational age) or extremely low birthweight (ELBW, <1000 g) are at risk of developmental delay and cerebral palsy (CP). The General Movements Assessment (GMA) and its extension, the Motor Optimality Score, revised (MOS-R) (assesses movement patterns and posture), may help to identify early delays., Objectives: To compare differences in the MOS-R scored from parent-recorded videos between infants born EP/ELBW and term-born infants, to determine relationships between the MOS-R and 2-year cognitive, language and motor outcomes and if any relationships differ between birth groups and the association of the GMA (fidgety) with CP., Methods: A geographical cohort (EP/ELBW and term-control infants) was assessed using the MOS-R inclusive of the GMA at 3- to 4-month corrected age (CA), and the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) at 2-year CA. Differences in mean total MOS-R between groups, relationships between MOS-R and 2-year outcomes and relationships between GMA (fidgety) and CP in infants born EP/ELBW were estimated using linear/logistic regression., Results: Three hundred and twelve infants (147 EP/ELBW; 165 term) had complete MOS-R and Bayley-III assessments. Mean MOS-R was lower in infants born EP/ELBW than controls (mean difference -3.2, 95% confidence interval [CI] -4.2, -2.3). MOS-R was positively related to cognitive (β [regression coefficient] = 0.71, 95% CI 0.27, 1.15), language (β = 0.96, 95% CI 0.38, 1.54) and motor outcomes (β = .89, 95% CI 0.45, 1.34). There was little evidence for interaction effects between birth groups for any outcome. Absent/abnormal fidgety movements were related to CP in children born EP/ELBW (risk ratio 5.91, 95% CI 1.48, 23.7)., Conclusions: Infants born EP/ELBW have lower MOS-R than infants born at term. A higher MOS-R is related to better outcomes for 2-year development, with similar relationships in both birth groups. Absent/abnormal fidgety movements are related to CP in EP/ELBW survivors., (© 2022 John Wiley & Sons Ltd.)

Aim: To determine the relationship between early motor repertoire and 2-year neurodevelopment in infants born extremely preterm (<28 weeks' gestation) or extremely-low-birthweight (ELBW) (<1000g)., Method: This was a geographical prospective cohort of 139 infants born extremely preterm/ELBW (mean gestational age 26.7 weeks, standard deviation [SD] 2.0, 68/139 [49%] male), with parent-recorded videos suitable for scoring the General Movements Assessment (GMA). Motor repertoire was assessed using the Motor Optimality Score-Revised (MOS-R), with and without the fidgety movement subsection, and the GMA alone at 12 to 13 +6  weeks corrected age and 14 to 15 +6  weeks corrected age. At 2 years corrected age, impaired development was defined as Bayley Scales of Infant and Toddler Development, Third Edition motor and cognitive development scores 1SD or less relative to controls born at term; paediatricians diagnosed cerebral palsy (CP)., Results: Greater MOS-R scores at 14 to 15 +6  weeks corrected age were associated with lower odds of CP (odds ratio [OR] per 1-point increase=0.83, 95% confidence interval [CI]=0.71-0.99), and motor (OR=0.93, 95% CI=0.87-0.99), or cognitive impairment (OR=0.94, 95% CI=0.88-0.99). Absent/abnormal GMA at 14 to 15 +6 weeks was associated with CP and motor delay. There was little evidence that MOS-R scores at 12 to 13 +6 weeks were associated with neurodevelopmental outcomes at 2 years., Interpretation: Poorer MOS-R scores and absent/abnormal GMA, scored from parent-recorded videos at 14 to 15 +6  weeks gestational age, are associated with CP and developmental impairment in 2-year-old infants born extremely preterm/ELBW., (© 2022 Mac Keith Press.)

Aim: To determine the effectiveness of two instructional guides to obtain video recordings for the General Movements Assessment (GMA)., Methods: A cross-sectional study of a community sample of family participants with low-risk term newborn infants recruited via social media and randomly allocated to receive one of two instructional guides (detailed or quick versions) to film their infant's movements at home. Participants returned videos via a secure Research Electronic Database Capture link and videos were scored for quality across 10 criteria, along with scoring the GMA. Participants were surveyed about their perceptions of the instructional guides and electronic file transmission., Results: Seventy-six parents of infants were enrolled and randomly allocated to receive detailed (n = 38) and quick (n = 38) instructions to film their infant for a GMA. Videos were returned by 87% (95% confidence interval (CI) 72%, 96%) of detailed instruction users and 84% (95% CI 69%, 94%) of quick instruction users. The GMA could be conducted on all returned videos. The mean score for video quality was 9.9/10 (standard deviation 0.4, 95% CI 9.7, 10.0) for detailed instructions and 9.7 (standard deviation 0.6, 95% CI 9.4, 9.9) for quick instructions. Overall, participants felt that either instructional guide was easy to use. Fifteen (20%) participants had difficulties with video file transmission, requiring additional support., Conclusions: Parents can successfully use one of two different instructional guides for filming their infant's movements for GMA; however, support should be provided for safe and easy file transmission., (© 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background: The relationship between early postnatal brain development and neurobehaviour at term-equivalent age (TEA) remains uncertain., Aim: We aimed to explore relationships between early postnatal cranial ultrasonography (cUS) linear measures of brain size and brain growth with neurobehaviour at TEA in infants born <30 weeks' gestational age (GA)., Study Design: Prospective observational cohort study., Subjects: 137 infants born <30 weeks' GA without major brain injury on neonatal cUS., Outcome Measures: Neurobehaviour at TEA assessed using the General Movements Assessment (GMA) and Hammersmith Neonatal Neurological Examination (HNNE)., Results: The GMA was administered in 115/137 (84%) infants; 80 (70%) presented with abnormal general movements (GMs) (79 poor repertoire, 1 cramped synchronised). The HNNE was assessed in 106/137 (77%) infants; 52 (49%) had a suboptimal total score. With respect to brain size, larger measures of the corpus callosum length (CCL) and right anterior horn width (AHW) at 1-month were related to lower risk of abnormal GMs, and larger measures of the biparietal diameter at 1-week and 2-months were related to lower risk of a suboptimal HNNE. As for brain growth, increases of the CCL and transcerebellar diameter between birth and 1-month, and left and right AHWs between 1- and 2-months, were related to lower risk of abnormal GMs., Conclusion: Early postnatal brain size and brain growth were related to neurobehaviour at TEA in infants born <30 weeks' GA. This study provides preliminary evidence for the prognostic utility of early postnatal cUS linear measures as potential markers of neurodevelopment in later childhood., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Neonatal conditions can have lifelong implications for the health and well-being of children and families. Traditionally, parents and patients have not been included in shaping the agenda for research and yet they are profoundly affected by the neonatal experience and its consequences. This study aimed to identify consensus research priorities among parents/patients of newborn medicine in Australia and New Zealand., Design: Parents/patients with experience of neonatal care in Australia and New Zealand completed an online Delphi study to identify research priorities across four epochs (neonatal admission, early childhood, childhood/adolescence and adulthood). Parents/patients first generated key challenges in each of these epochs. Through inductive thematic analysis, recurring topics were identified and research questions generated. Parents/patients rated these questions in terms of priorities and a list of questions consistently rated as high priority was identified., Participants: 393 individuals participated, 388 parents whose children had received neonatal care and 5 adults who had received neonatal care themselves., Results: Many research questions were identified as high-priority across the lifespan. These included how to best support parental mental health, relationships between parents and neonatal clinical staff (including involvement in care and communication), bonding and the parent-child relationship, improving neonatal medical care and addressing long-term impacts on child health and neurodevelopment., Conclusions: Parents with experience of newborn medicine have strong, clear and recurring research priorities spanning neonatal care practices, psychological and other impacts on families, and impacts on child development. These findings should guide neonatal research efforts. In addition to generating new knowledge, improved translation of existing evidence to parents is also needed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To explore the experiences of neonatal nurses in the implementation of a tool to enhance relationships between staff and parents in the neonatal unit: the You and Your Baby Nursery Guide., Design: Qualitative descriptive design with focus groups., Setting: The study took place in a Level 4, 20-bed neonatal unit in Melbourne, Victoria, Australia., Participants: Purposive sample of seven registered nurses who worked day or afternoon shifts., Methods: We conducted two semistructured focus groups after a 4-week implementation period of the You and Your Baby Nursery Guide. Participants completed a weekly reflective journal throughout the implementation period. We audiotaped and transcribed the focus groups and qualitatively analyzed the interview data with the use of thematic analysis., Results: Use of the guide helped transform the relationships between parents and staff. The use of the guide enhanced communication, promoted participants' personal reflection on their clinical skills and style/approach to parent engagement, and directly affected the care participants provided to infants and families., Conclusion: The You and Your Baby Nursery Guide was a useful resource to facilitate the delivery of family-centered, developmentally supportive care., (Copyright © 2020 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Background: Prechtl's general movements assessment (GMA) post-term has high predictive validity for cerebral palsy, but less is known about whether earlier GMA, including before term, are associated with other developmental problems., Aims: To examine the relationships between GMA prior to term and at term-equivalent, with developmental outcomes at 4.5-5 years' corrected age., Study Design: Prospective cohort study., Subjects: 122 very preterm infants born <30 weeks' gestation and 91 healthy term controls., Outcome Measures: GMA (categorised as 'normal' or 'abnormal') were assessed at <32, 32-33 and 34-36 weeks' postmenstrual age for the preterm infants, and at term-equivalent for both groups. Children were assessed at 4.5-5 years' corrected age using the Movement Assessment Battery for Children-2nd edition (MABC-2), Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), Pediatric Quality of Life Inventory (PedsQL), Little Developmental Coordination Disorder Questionnaire (Little DCD-Q) and Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV)., Results: Prior to term, abnormal GMA at the first two timepoints were associated with lower scores on the Little DCD-Q, and abnormal GMA at the second and third timepoints with lower quality of life scores and PEDI-CAT mobility domain scores. Abnormal GMA at term-equivalent were associated with lower MABC-2, mobility and quality of life scores for preterm infants, and worse social/cognitive domain scores for both groups., Conclusions: Abnormal GMA prior to term and at term-equivalent are associated with worse motor, functional and cognitive outcomes at 4.5-5 years' corrected age, and may be useful to identify infants for developmental surveillance/early intervention., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Fidgety general movements have high predictive validity for later cerebral palsy (CP) but their temporal organisation requires further understanding for assessment accuracy., Aims: To describe the occurrence of and temporal trends in fidgety movements, and whether they differ between infants born preterm and at term., Study Design: Cohort study., Subjects: We assessed 155 EP/ELBW infants and 185 term-born infants born extremely preterm (EP; <28 weeks' gestation) and/or extremely low birthweight (ELBW; <1000 g birthweight) or at term (37-42 weeks' gestation) in the state of Victoria, Australia., Outcome Measures: Parents of infants submitted up to two videos at 12-13 +6 and/or 14-16 +6 weeks' corrected age of infants' general movements. Videos were scored using the Prechtl General Movements Assessment (GMA) (fidgety) and classified as normal or absent/abnormal. Infants with at least one normal GMA were classified as normal. Individual GMA trajectories were analysed over time using logistic regression., Results: Overall, infants born EP/ELBW were more likely to have absent/abnormal fidgety movements than term-born infants (23% versus 3%, odds ratio [OR] 8.50 (95% confidence interval (CI) 3.48-20.8, p < 0.001). Fewer EP/ELBW and term-born infants showed absent/abnormal fidgety movements with each week of increasing age (EP/ELBW OR 0.46, 95% CI 0.25-0.84, p = 0.01; term-born OR 0.35, 95% CI 0.16-0.8, p = 0.01; interaction, p = 0.53)., Conclusions: Absent/abnormal fidgety movements are more prevalent in infants born EP/ELBW than at term. Fidgety movements normalise with older age in both infants born EP/ELBW and at term between 12 and 16 +6 weeks' corrected age., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aim: To examine: (1) relationships between brain structure, and concurrently assessed neurological and behavioural functioning, in infants born preterm at term-equivalent age (TEA; approximately 38-44wks); and (2) whether brain structure-function relationships differ between infants born very (24-29wks) and moderate-late (32-36wks) preterm., Method: A total of 257 infants (91 very preterm, 166 moderate-late preterm; 120 males, 137 females) had structural magnetic resonance imaging (MRI) and neurological and behavioural assessments (Prechtl's general movements assessment, Neonatal Intensive Care Unit Network Neurobehavioral Scale [NNNS] and Hammersmith Neonatal Neurological Examination [HNNE]). Two hundred and sixty-three infants (90 very preterm, 173 moderate-late preterm; 131 males, 132 females) had diffusion MRI and assessments. Associations were investigated between assessment scores and global brain volumes using linear regressions, regional brain volumes using Voxel-Based Morphometry, and white matter microstructure using Tract-Based Spatial Statistics., Results: Suboptimal scores on some assessments were associated with lower fractional anisotropy and/or higher axial, radial, and mean diffusivities in some tracts: NNNS attention and reflexes, and HNNE total score and tone, were associated with the corpus callosum and optic radiation; NNNS quality of movement with the corona radiata; HNNE abnormal signs with several major tracts. Brain structure-function associations generally did not differ between the very and moderate-late preterm groups., Interpretation: White matter microstructural alterations may be associated with suboptimal neurological and behavioural performance in some domains at TEA in infants born preterm. Brain structure-function relationships are similar for infants born very preterm and moderate-late preterm., What This Paper Adds: Brain volume is not related to neurological/behavioural function in infants born preterm at term. White matter microstructure is related to some neurological/behavioural domains at term. Brain-behaviour relationships are generally similar for infants born very preterm and moderate-late preterm., (© 2018 Mac Keith Press.)

Aim: The Baby Moves smartphone application is designed for parents to video their infants' spontaneous movement for remote General Movements Assessment (GMA). We aimed to assess the engagement with Baby Moves amongst high- and low-risk infants' families and the socio-demographic variables related to engagement., Methods: Families of extremely preterm (EP; <28 weeks' gestational age) or extremely low-birthweight (ELBW; <1000 g) infants and term-born controls from a state-wide geographical cohort study were asked to download Baby Moves. Baby Moves provided reminders and instructions to capture videos of their infants' general movements. Parents were surveyed about Baby Moves' usability., Results: The parents of 451 infants (226 EP/ELBW; 225 control) were recruited; 416 (204 EP/ELBW; 212 control) downloaded Baby Moves, and 346 (158 EP/ELBW; 188 control) returned at least one scorable video for remote GMA. Fewer EP/ELBW families submitted a scorable video than controls (70 vs. 83%, respectively; odds ratio (OR) 0.48, 95% confidence interval (CI) 0.3-0.79, P = 0.003), but the difference diminished when adjusted for socio-demographic variables (OR 1.09, 95% CI 0.59-2.0, P = 0.79). Families who received government financial support (OR 0.28, 95% CI 0.1-0.78, P = 0.015), who spoke limited English at home (OR 0.39, 95% CI 0.22-0.69, P = 0.001) or with lower maternal education (OR 0.38, 95% CI 0.21-0.68, P = 0.001) were less likely to return a scorable video. Surveyed parents responded mostly positively to Baby Moves' usability., Conclusions: Most parents in this study successfully used Baby Moves to capture infant movements for remote GMA. Families of lower socio-demographic status used Baby Moves less., (© 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Aim: To examine the associations between Prechtl's General Movements Assessment (GMA), conducted from birth to term-equivalent age, and neurodevelopmental outcomes at 12 months corrected age, in infants born very preterm., Method: One hundred and thirty-seven infants born before 30 weeks' gestation had serial GMA (categorized as 'normal' or 'abnormal') before term and at term-equivalent age. At 12 months corrected age, neurodevelopment was assessed using the Alberta Infant Motor Scale (AIMS); Neurological, Sensory, Motor, Developmental Assessment (NSMDA); and Touwen Infant Neurological Examination (TINE). The relationships between GMA at four time points and 12-month neurodevelopmental assessments were examined using regression models., Results: Abnormal GMA at all time points were associated with worse continuous scores on the AIMS, NSMDA, and TINE (p<0.05). Abnormal GMA before term and at term-equivalent age were associated with increased odds of mild-severe dysfunction on the NSMDA (odds ratio [OR] 4.26, 95% confidence interval [CI] 1.55-11.71, p<0.01; and OR 4.16, 95% CI 1.55-11.17, p<0.01 respectively) and abnormal GMA before term with increased odds of suboptimal-abnormal motor function on the TINE (OR 2.75, 95% CI 1.10-6.85, p=0.03)., Interpretation: Abnormal GMA before term and at term-equivalent age were associated with worse neurodevelopment at 12 months corrected age in children born very preterm., What This Paper Adds: Abnormal general movements before term predict developmental deficits at 1 year in infants born very preterm. General Movements Assessment before term identifies at-risk infants born very preterm., (© 2017 Mac Keith Press.)

Objective: To compare the physiological stress responses of infants born <30 weeks' gestational age when undergoing clustered nursing cares with standardised neurobehavioural assessments in neonatal nurseries., Design/methods: Thirty-four infants born <30 weeks' gestation were recruited from a tertiary neonatal intensive care unit. Heart rate (HR) and oxygen saturation were recorded during clustered nursing cares and during standardised neurobehavioural assessments (including the General Movements Assessment, Hammersmith Neonatal Neurological Examination and Premie-Neuro Assessment). Two assessors extracted HR and oxygen saturations at 5 s intervals, with HR instability defined either as tachycardia (HR >180 beats per minute (bpm)) or bradycardia (HR <100 bpm). Oxygen desaturations were defined as SpO 2 <90%. Physiological stability was compared between nursing cares and neurobehavioural assessments using linear (for continuous outcomes) and logistic (HR instability and oxygen desaturation) regression., Results: Compared with clustered nursing cares HR was lower (mean difference -5.9 bpm; 95% CI -6.5 to 5.3; P<0.001) and oxygen saturation higher (mean difference 2.4%; 95% CI 2.1% to 2.6%; P<0.001) during standardised neurobehavioural assessments. Compared with clustered nursing cares neurobehavioural assessments were also associated with reduced odds of tachycardia (OR 0.44, 95% CI 0.22 to 0.86), HR instability (OR 0.43, 95% CI 0.22 to 0.85) and oxygen desaturation (OR 0.43, 95% CI 0.26 to 0.70)., Conclusions: Standardised neurobehavioural assessments are associated with less physiological stress than clustered nursing cares in infants aged 29-32 weeks' postmenstrual age, and are therefore possible without causing undue physiological disturbance in medically stable infants., Competing Interests: Competing interests: AJS is a member of the General Movements Trust, a not-for-profit organisation, involved in training the General Movements Assessment. The other authors have no potential conflicts of interest relevant to this article to disclose.

Background: Infants born very preterm (VPT) and moderate-to-late preterm (MLPT) are at increased risk of long-term neurodevelopmental deficits, but how these deficits relate to early neurobehaviour in MLPT children is unclear. The aims of this study were to compare the neurobehavioural performance of infants born across three different gestational age groups: preterm <30 weeks' gestational age (PT<30); MLPT (32-36 weeks' gestational age) and term age (≥37 weeks' gestational age), and explore the relationships between MRI brain abnormalities and neurobehaviour at term-equivalent age., Methods: Neurobehaviour was assessed at term-equivalent age in 149 PT<30, 200 MLPT and 200 term-born infants using the Neonatal Intensive Care UnitNetwork Neurobehavioral Scale (NNNS), the Hammersmith Neonatal Neurological Examination (HNNE) and Prechtl's Qualitative Assessment of General Movements (GMA). A subset of 110 PT<30 and 198 MLPT infants had concurrent brain MRI., Results: Proportions with abnormal neurobehaviour on the NNNS and the HNNE, and abnormal GMA all increased with decreasing gestational age. Higher brain MRI abnormality scores in some regions were associated with suboptimal neurobehaviour on the NNNS and HNNE. The relationships between brain MRI abnormality scores and suboptimal neurobehaviour were similar in both PT<30 and MLPT infants. The relationship between brain MRI abnormality scores and abnormal GMA was stronger in PT<30 infants., Conclusions: There was a continuum of neurobehaviour across gestational ages. The relationships between brain abnormality scores and suboptimal neurobehaviour provide evidence that neurobehavioural assessments offer insight into the integrity of the developing brain, and may be useful in earlier identification of the highest-risk infants., Competing Interests: Competing interests: None declared.

Neurobehavioral assessments provide insight into the functional integrity of the developing brain and help guide early intervention for preterm (<37 weeks' gestation) infants. In the context of shorter hospital stays, clinicians often need to assess preterm infants prior to term equivalent age. Few neurobehavioral assessments used in the preterm period have established interrater reliability., Aim: To evaluate the interrater reliability of the Hammersmith Neonatal Neurological Examination (HNNE) and the NICU Network Neurobehavioral Scale (NNNS), when used both preterm and at term (>36 weeks)., Methods: Thirty-five preterm infants and 11 term controls were recruited. Five assessors double-scored the HNNE and NNNS administered either preterm or at term. A one-way random effects, absolute, single-measures interclass correlation coefficient (ICC) was calculated to determine interrater reliability., Results: Interrater reliability for the HNNE was excellent (ICC > 0.74) for optimality scores, and good (ICC 0.60-0.74) to excellent for subtotal scores, except for 'Tone Patterns' (ICC 0.54). On the NNNS, interrater reliability was predominantly excellent for all items. Interrater agreement was generally excellent at both time points., Conclusions: Overall, the HNNE and NNNS neurobehavioral assessments demonstrated mostly excellent interrater reliability when used prior to term and at term.

Background: Neurodevelopmental assessments and brain magnetic resonance imaging (MRI) at term-equivalent age (TEA) predict developmental outcomes in preterm infants. However, the relationship between neurodevelopment prior to term and cerebral structure is currently unknown., Aims: To examine the relationships between General Movements (GMs) assessed from birth to TEA and brain MRI at TEA in infants born <30weeks' gestation., Study Design: Prospective cohort study. GMs (categorised as 'normal' or 'abnormal') were recorded weekly from birth to 32weeks, and at 34 and 36weeks' postmenstrual age. At TEA, GMs were assessed concurrently with brain MRI (using a validated scoring system)., Subjects: 149 infants born <30weeks' gestation were recruited from a tertiary hospital., Results: 103 infants had MRI at TEA and GMs recorded. Abnormal GMs prior to term were associated with cortical grey matter abnormality (p<0.03), deep grey matter abnormality (p=0.02) and increased interhemispheric distance (p<0.02). Abnormal GMs at TEA (n=55/90) were associated with more global brain abnormality (p<0.01) and cortical grey matter abnormality (p=0.01), and decreased transcerebellar diameter (p=0.04) on concurrent brain MRI., Conclusions: Abnormal GMs both prior to term and at TEA were associated with more marked brain abnormality, and smaller brains at TEA. Abnormal GMs are an early marker of brain abnormalities in very preterm infants., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Aims: The objective of this study was to generate reference values for infants born moderate preterm (MPT), late preterm (LPT) and full term (FT) for three newborn neurobehavioural/neurological examinations in the first weeks after birth., Study Design: Prospective cohort study to examine the expected range of values for MPT (born 32(+0) to 33(+6)), LPT (34(+0) to 36(+6)) and FT (born 37 to 42weeks' gestation) infants' performance on the Hammersmith Neonatal Neurological Examination (HNNE), the Neonatal Intensive Care Unit Network Neurobehavioural Scale (NNNS) and Prechtl's General Movements Assessment (GMA) in the first weeks after birth. Further, to determine the effects of sex, gestational age at birth, and postmenstrual age at assessment on the 3 different assessments within the gestational age groups., Subjects: 80 MPT, 129 LPT and 201 FT infants were recruited shortly after birth from a tertiary hospital., Results: The means, standard deviations and 5th, 10th, 25th, 50th, 75th, 90th and 95th centiles are presented for the HNNE and NNNS for each of the three gestational age groups. Overall, FT infants performed better than MPT and LPT infants. The rate of normal GMA within the first few weeks after birth was 25% for MPT, 32% for LPT, and 90% for FT infants. The effects of sex, gestational age at birth, and postmenstrual age at assessment varied between test and gestational age groups., Conclusions: This study provides normative data for the HNNE, NNNS, and GMA administered within the first weeks after birth in a sample of MPT, LPT and healthy FT infants., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: General movements (GMs) is an assessment with good predictive validity for neurodevelopmental outcomes in preterm infants. However, there is limited information describing the early GMs of very preterm infants, particularly prior to term., Aims: To describe the early GMs trajectory of very preterm infants (born <30weeks' gestation) from birth to term-equivalent age, and to assess the influence of known perinatal risk factors on GMs., Study Design: Prospective cohort study., Subjects: 149 very preterm infants born <30weeks' gestation., Outcome Measures: GMs were recorded weekly from birth until 32weeks' postmenstrual age, and then fortnightly until 38weeks' postmenstrual age. GMs were also assessed at term-equivalent age. Detailed perinatal data were collected., Results: Of 669 GMs assessed, 551 were preterm and 118 were at term-equivalent age. Prior to term, 15% (n=82) of GMs were normal and 85% (n=469) were abnormal, with the proportion of abnormal GMs decreasing with increasing postmenstrual age (p for trend <0.001). By term-equivalent 30% (n=35) of GMs were normal. On univariable analysis, lower gestational age (p<0.001), postnatal infection (p<0.001) and bronchopulmonary dysplasia (p=0.001) were associated with abnormal GMs. Postnatal infection was the only independent perinatal association with abnormal GMs on multivariable analysis. All four infants with grade III/IV intraventricular haemorrhage (IVH) had persistently abnormal GMs., Conclusions: GMs were predominantly abnormal in very preterm infants, with a higher proportion of normal GMs at term-equivalent age than prior to term. Abnormal GMs were associated with postnatal infection and IVH., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Very preterm (VPT) children have different sensory profiles than term-born controls, but how the sensory profiles in VPT children relate to development has not been reported., Aim: The aim of this study was to examine the relationship between VPT infant sensory profiles and concurrent developmental outcomes at 2 years' corrected age., Study Design: Cohort study., Subjects: 243 children <30 weeks' gestation., Outcome Measures: Primary caregivers completed the Infant/Toddler Sensory Profile Questionnaire to obtain information on sensory processing at 2 years of age. Independent observers assessed the child's neurodevelopment with either the Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development version 2 (Bayley 2) or the Cognition, Language and Motor Composites of the Bayley Scales of Infant and Toddler Development version 3 (Bayley 3)., Results: A stronger Low Registration pattern correlated with lower MDI and PDI scores and a stronger Sensation Avoiding pattern correlated with a lower PDI score. A stronger Low Registration pattern correlated with a lower Language Composite score. More frequent visual and oral sensory processing behaviours were associated with higher performance on the MDI and PDI, with more frequent auditory sensory processing behaviours also associated with higher PDI scores. More frequent auditory, touch and oral sensory processing behaviours were associated with improved outcomes on the Language Composite and more frequent auditory, touch and vestibular processing behaviours correlated with improved outcomes on the Cognition Composite. A secondary analysis using a computed MDI score derived from the Bayley 3 scores did not substantially alter any conclusions., Conclusion(s): Different sensory profile patterns obtained from parental reports of VPT children are associated with various aspects of neurodevelopment at 2 years of age, obtained from independent assessment., (© 2013.)

Background: Sensory profiles are increasingly used by therapists to assess children. There is limited information on how sensory profiles differ between very preterm (VPT) children and term controls, or on the predictors of sensory profiles in VPT children., Aims: The aim of this study was to examine sensory profiles of children born <30 weeks' gestation at 2 years and their environmental and biological influences., Study Design: Cohort study., Subjects: 253 VPT children born <30 weeks' gestation and 65 term-born controls (>36 weeks' gestation)., Outcome Measures: Sensory profiles were examined with the Infant/Toddler Sensory Profile Questionnaire, which measures the child's responsiveness in four sensory quadrants and in five sensory processing sections. Standardised z scores for the VPT sample were compared with the controls, and predictors of VPT infant sensory profiles were determined., Results: VPT children had scores consistent with stronger patterns across all four sensory quadrants compared with controls, indicating a stronger interaction between neurological thresholds to elicit a response and self-regulation strategies. In addition they also exhibited more of the behaviours in all sensory processing sections compared with controls. Male sex, higher social risk, increasing length of stay, and moderate to severe white matter abnormality on MRI at term-equivalent age were associated with stronger sensory profile patterns in some quadrants, and more behaviours in some sensory processing sections., Conclusions: Sensory profiles differed between VPT children and term-born controls, with stronger sensory profile patterns associated with male sex, higher social risk, longer hospital stay, and moderate to severe white matter abnormality., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: Although ~50% of very preterm (VP) children have neurodevelopmental impairments, early prediction of infants who will experience problems later in life remains a challenge. This study evaluated the predictive value of general movements (GM; spontaneous and endogenous movements) at 1 and 3 months' corrected age for neurodevelopment at 2 and 4 years of age in VP children., Methods: At 1 and 3 months' corrected age, infants born <30 weeks' gestation had GM assessed as normal or abnormal. Motor, cognitive, and language development at 2 years was assessed by using the Bayley Scales of Infant and Toddler Development, Third Edition. At 4 years, cognitive and language outcomes were assessed by using the Differential Ability Scale-Second Edition and motor outcomes with the Movement Assessment Battery for Children-Second Edition; a diagnosis of cerebral palsy was documented., Results: Ninety-nine VP infants were recruited, with 97% and 88% of survivors followed up at age 2 and 4 years, respectively. Abnormal GM at 1 month were associated with worse motor outcomes at 2 and 4 years but not language or cognitive outcomes. Abnormal GM at 3 months were associated with worse motor, cognitive, and language outcomes at both 2 and 4 years. Overall, GM at 1 month demonstrated better sensitivity to impairments at 2 and 4 years, whereas GM at 3 months had better specificity and were more accurate overall at distinguishing between children with and without impairment., Conclusions: Abnormal GM in VP infants, particularly at 3 months postterm, are predictive of worse neurodevelopment at ages 2 and 4 years.

Aim: To assess the predictive validity of the Bayley Scales of Infant and Toddler Development - Third Edition (Bayley-III) for later motor outcome., Method: Ninety-six infants (49 males, 47 females) born at less than 30 weeks' gestation admitted to two tertiary hospitals in Melbourne, Australia, were assessed with the Bayley-III Motor Scale at 2 years' corrected age and were classified as suspect or definite motor impairment if they scored less than -1 or -2 standard deviations respectively, relative to the test mean. At 4 years' corrected age, children completed Movement Assessment Battery for Children - Second Edition (MABC-2); for the total motor score, cut-offs of not more than the 15th were used to classify motor development and cut-offs of not more than the 15th centile were classified as having a significant movement difficulty., Results: Of the 96 children assessed at both ages, at 2 years 9% had suspect and 4% had definite motor impairment; however, by 4 years, rates had increased to 22% and 19% respectively. The specificity of the Bayley-III for motor impairments for later motor outcome was excellent (ranging from 94 to 100% for cerebral palsy [CP] and 97 to 100% for motor impairment), although the sensitivity was low (ranging from 67 to 83% for CP and 18 to 37% for motor impairment); many children with later impairment were not identified by the Bayley-III., Interpretation: The Bayley-III Motor Scale at 2 years underestimates later rates of motor impairment, particularly in the absence of CP at 4 years on the MABC-2 total motor score in children born at less than 30 weeks' gestational age., (© The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.)

Aim: The aim of the study was to evaluate the psychometric properties and clinical use of assessments of sensory processing function, within the first 2 years of life, and to identify which assessment is the most appropriate and precise in measuring the construct of sensory processing., Method: The literature was comprehensively searched, and assessments used to measure sensory processing in infancy were systematically selected and reviewed for clinical use, reliability, validity, and responsiveness., Results: Thirty-four assessments were identified; three met the predefined inclusion criteria. All discriminative assessments, the Sensory Rating Scale, and Infant/Toddler Sensory Profile are parent-reported questionnaires and can be administered from birth up to 3 years of age. The Test of Sensory Function in Infants is a performance-based assessment and is suitable for infants aged 4 to 18 months. Studies evaluating the psychometric properties of these three assessments differed in the properties addressed and reported poor to adequate reliability., Interpretation: Selecting the most appropriate and precise assessment to measure sensory processing function in infancy will depend on the specific components of sensory processing that need to be evaluated, infant age, and what other sources of information are available about the infant's development., (© The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.)