Acid-base status at birth, spontaneous motor behaviour at term and 3 months and neurodevelopmental outcome at age 4 years in full-term infants.

OBJECTIVE The aim of the study was to assess the relationship between acid-base status and quality and quantity of General Movements (GMs) at birth and quality of GMs at age 3 months and motor, cognitive and behavioural functioning at the age of 4 years. METHODS From a cohort of 84 term children with different umbilical artery pH without severe neonatal neurological abnormalities, GMs were assessed at term and at 3 months. At the age of 4 years, 44 children were assessed by means of the Movement Assessment Battery for Children (Movement-ABC), Neurological Examination for Toddlers of Hempel, Kaufman Assessment Battery for Children information processing (Kaufman ABC), Visuomotor Integration (VMI), the Child Behaviour Checklist (CBCL) and Precursors ADHD Questionnaire (PAQ). RESULTS We found no relationship between pH or GM-quality and quantity at term or GM-quality at 3 months and scores on most of the items of the Movement-ABC, cognitive and behavioural outcome. However, neonatal pH value and GM-quality at 3 months were related to some extent to the presence of subtle signs of neuromotor dysfunction as measured by the Hempel test. CONCLUSIONS In a sample of infants with a large variation in umbilical artery pH and without severe neonatal neurological abnormalities, acid-base status at birth and quality of GMs at 3 months of age is not predictive for motor milestone achievement, cognitive and behavioural functioning at 4 years, but these parameters are related to a less optimal condition of the nervous system. The latter finding has, however, limited clinical significance.

[1]  V. V. Kranen-Mastenbroek.  Spontaneous motor behaviour in full-term small for gestational age and appropriate for gestational age newborn infants , 1993 .

[2]  M. Hadders‐Algra.  The assessment of General Movements is a valuable technique for the detection of brain dysfunction in young infants. A review , 1996, Acta paediatrica (Oslo, Norway : 1992). Supplement.

[3]  P. Yudkin,et al.  Acid-base status at birth and neurodevelopmental outcome at four and one-half years. , 1989, American journal of obstetrics and gynecology.

[4]  Giovanni Cioni,et al.  An early marker for neurological deficits after perinatal brain lesions , 1997, The Lancet.

[5]  K. Leveno,et al.  Pathologic Fetal Acidemia , 1991, Obstetrics and gynecology.

[6]  H W Jongsma,et al.  Neonatal complications in newborns with an umbilical artery pH < 7.00. , 1996, American journal of obstetrics and gynecology.

[7]  M. Hadders‐Algra,et al.  Quality of general movements in infancy is related to neurological dysfunction, ADHD, and aggressive behaviour , 1999, Developmental medicine and child neurology.

[8]  G Cioni,et al.  Qualitative changes of general movements in preterm infants with brain lesions. , 1990, Early human development.

[9]  R. V. Oostenbrugge,et al.  Inter- and intra-observer agreement in the assessment of the quality of spontaneous movements in the newborn , 1992, Brain & development (Tokyo. 1979).

[10]  I. Ingemarsson,et al.  Long term outcome after umbilical artery acidaemia at term birth: influence of gender and duration of fetal heart rate abnormalities , 1997, British journal of obstetrics and gynaecology.

[11]  J. Low,et al.  Newborn complications after intrapartum asphyxia with metabolic acidosis in the preterm fetus. , 1994, American journal of obstetrics and gynecology.

[12]  F. Walther,et al.  Umbilical arteriovenous PO2 and PCO2 differences and neonatal morbidity in term infants with severe acidosis. , 1998, American journal of obstetrics and gynecology.

[13]  J. Hauth,et al.  Neonatal complications at term as related to the degree of umbilical artery acidemia. , 1991, American journal of obstetrics and gynecology.

[14]  Two distinct forms of minor neurological dysfunction: perspectives emerging from a review of data of the Groningen Perinatal Project , 2002 .

[15]  J. Low,et al.  Threshold of metabolic acidosis associated with newborn complications. , 1997, American journal of obstetrics and gynecology.

[16]  M. Rutherford,et al.  CRANIAL ULTRASOUND AND MAGNETIC RESONANCE IMAGING IN HYPOXIC‐ISCHAEMIC ENCEPHALOPATHY: A COMPARISON WITH OUTCOME , 1994, Developmental medicine and child neurology.

[17]  G. Visser,et al.  The relationship between the quantity and quality of prenatal movements in pregnancies complicated by intra‐uterine growth retardation and premature rupture of the membranes , 1992, Early human development.

[18]  I. Ingemarsson,et al.  Different types of acid‐base changes at birth, fetal heart rate patterns, and infant outcome at 4 years of age , 1997, Acta obstetricia et gynecologica Scandinavica.

[19]  G. Cioni,et al.  Posture, spontaneous movements, and behavioural state organisation in infants affected by brain malformations. , 1997, Early human development.

[20]  G. Cioni,et al.  Predictive value of general movements in asphyxiated fullterm infants. , 1993, Early human development.

[21]  K. Murphy,et al.  Clustering of perinatal markers of birth asphyxia and outcome at age five years , 1994, British journal of obstetrics and gynaecology.

[22]  G. Cioni,et al.  Which better predicts later outcome in full-term infants: quality of general movements or neurological examination? , 1997, Early human development.

[23]  R. Largo,et al.  Prognostic Value of Early MR Imaging in Term Infants with Severe Perinatal Asphyxia , 1994, Neuropediatrics.

[24]  G. Cioni,et al.  Kinematic and qualitative analysis of lower-extremity movements in preterm infants with brain lesions. , 1999, Physical therapy.

[25]  G Cioni,et al.  Comparison between observation of spontaneous movements and neurologic examination in preterm infants. , 1997, The Journal of pediatrics.

[26]  K. Zerres,et al.  Behavioural problems in children and adolescents with spinal muscular atrophy and their siblings. , 2003, Developmental medicine and child neurology.

[27]  M. Handley-Derry,et al.  Intrapartum fetal asphyxia and the occurrence of minor deficits in 4‐to 8‐year‐old children , 1997, Developmental medicine and child neurology.

[28]  M. Hadders‐Algra,et al.  Quality of general movements and the development of minor neurological dysfunction at toddler and school age , 2004, Clinical rehabilitation.

[29]  M. Hempel.  Neurological development during toddling age in normal children and children at risk of developmental disorders. , 1993, Early human development.