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Table 3 Definitions of concepts

From: The general movements assessment in term and late-preterm infants diagnosed with neonatal encephalopathy, as a predictive tool of cerebral palsy by 2 years of age: a scoping review protocol

Concepts

Definition

Neonatal encephalopathy

A clinically defined syndrome of disturbed neurologic function in the earliest days of life in an infant born at or beyond 35 weeks of gestation, manifested by a subnormal level of consciousness or seizures, and often accompanied by difficulty with initiating and maintaining respiration and depression of tone and reflexes [3]

Late-preterm

Neonates ≥ 34 + 0 to 36 + 6 weeks GA [30]

Term

Neonates 37 + 0 to 42 + 6 weeks GA [30]

Cerebral palsy

A group of permanent disorders of the development of movement and posture causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain [31]

General movements

These are spontaneous movements present from early fetal life until about 6 months of life. GMs are variable, complex movements that occur frequently, lasting long enough to be observed. The whole body is involved in a variable sequence of limbs, neck, and trunk movements. Waxing and waning in intensity, force, and speed, they have a gradual beginning and end. They involve rotations along the limb axis. Slight changes in direction are responsible for their fluid elegance. Impairment of the nervous system causes the loss of GMs complexity and variability resulting in monotonous and poor-quality movements.

Specific abnormal GM patterns have been identified that reliably predict later cerebral palsy:

(1) Cramped-synchronized GMs—a persistence of rigid movements that lack the normal fluidity. Contractions and relaxations occur almost concurrently in limb and trunk muscles.

(2) The absence of fidgety GMs—fidgety movements are small movements of moderate speed with variable acceleration of neck, trunk, and limbs in all directions. Normally, they are the predominant movement pattern in an awake infant at 3 to 5 months [32].

General movements assessment

A comfortably dressed infant, preferably with bare arms and legs, is videoed in supine position. The duration of the video recording will depend on the age of the infant with premature infants requiring up to 30 to 60 minutes. Term age and older require 5 to 10 min of optimal recording. This recording does not require the observer’s presence. The trained observer reviews the recording later. The assessment is based on global visual Gestalt perception without acoustic signal to reduce distraction. Two to three recordings of the preterm, one recording at term or early post-term age or both, and at least one recording between 9- and 15-week post-term forms the basis of a developmental trajectory. An individual developmental trajectory indicates the consistency or inconsistency of normal or abnormal findings [32].

Sensitivity

The proportion of true positives that are correctly identified in a sample, or the true positive rate [33].

Specificity

The proportion of true negatives that are correctly identified in a sample, or the true negative rate [33].

Positive predictive value

The proportion of patients with positive test results who are correctly diagnosed [34].

Negative predictive value

The proportion of patients with negative test results who are correctly diagnosed [34].

  1. Note. GA gestational age, GMs general movements