Tabla I. Valoración del riesgo de sesgo según la Newcastle-Ottawa Scale. |
|||||||||||
Prechtl |
Ferrari |
Seme-Ciglene- |
Romeo |
Brogna |
Spittle |
Skiöld |
Øberg |
Dimitrijevic |
De Bock |
||
Selección |
Representatividad de la cohorte de expuestos |
* |
* |
– |
* |
* |
– |
– |
– |
– |
* |
Selección de la cohorte de no expuestos |
– |
– |
– |
– |
– |
– |
– |
– |
– |
– |
|
Conocimiento de la exposición |
* |
* |
* |
* |
* |
* |
* |
* |
* |
* |
|
Demostración de que el evento de interés no estaba presente en el inicio del estudio |
* |
* |
* |
* |
* |
* |
* |
* |
* |
* |
|
Comparabilidad |
Comparabilidad de las cohortes en la base del diseño |
** |
** |
** |
** |
** |
** |
** |
** |
** |
** |
Resultados |
Conocimiento de la exposición |
* |
* |
– |
* |
* |
* |
* |
* |
* |
* |
¿Fue el seguimiento suficientemente largo para que sucediera el resultado? |
* |
* |
* |
* |
* |
* |
* |
* |
* |
* |
|
Idoneidad del seguimiento de las cohortes |
* |
* |
* |
* |
* |
* |
– |
* |
* |
* |
|
Total |
8 |
8 |
6 |
8 |
8 |
7 |
6 |
7 |
7 |
8 |
Tabla II. Características generales de los estudios. |
|||||
Diseño del estudio |
Tamaño de la muestra |
Edad gestacional (semanas) |
Media gestacional (semanas) |
Sexo (H/M) |
|
Prechtl et al [17] |
Cohortes |
130 |
26-37 |
32 |
78/52 |
Ferrari et al [18] |
Cohortes |
84 |
< 37 |
30,2 ± 2,3 |
NM |
Seme-Ciglenecki et al [19] |
Cohortes |
112 |
< 37 |
33 |
57/55 |
Romeo et al [20] |
Cohortes |
903 |
< 37 |
34,5 ± 2,3 |
496/407 |
Brogna et al [21] |
Cohortes |
574 |
34-36 |
35,0 ± 1,0 |
NM |
Spittle et al [22] |
Cohortes |
99 |
< 30 |
27,3 ± 1,5 |
50/49 |
Skiöld et al [23] |
Cohortes |
53 |
< 27 |
25,4 ± 1,0 |
32/21 |
Øberg et al [24] |
Cohortes |
87 |
< 37 |
30,5± 1,5 |
47/40 |
Dimitrijevic et al [25] |
Cohortes |
79 |
< 37 |
33,6 ± 2,3 |
41/38 |
De Bock et al [26] |
Cohortes |
122 |
< 33 |
28,4 ± 3,0 |
NM |
H: hombre; M: mujer; NM: no se menciona. |
Tabla III. Movimientos generales y parálisis cerebral. |
|||||||||
Valoración de los movimientos generales |
Desarrollo de parálisis cerebral |
Total de parálisis cerebral |
p |
Sensibilidad |
Especificidad |
||||
Clasificación de Hadders-Algra |
Skiöld et al [23] |
Normal óptimo: 14 Normal subóptimo: 22 Moderadamente anormal: 11 Claramente anormal: 6 |
Normal óptimo: 0 Normal subóptimo: 1 Moderadamente anormal: 1 Claramente anormal: 2 |
4 |
0,03 |
50% |
92% |
||
De Bock et al [26] |
Normal óptimo: 16 Normal subóptimo: 0 Moderadamente anormal: 74 Claramente anormal: 32 |
Normal óptimo: 0 Normal subóptimo: 0 Moderadamente anormal: 0 Claramente anormal: 6 |
6 |
0,004 |
100% |
77,6% |
|||
Clasificación de Prechtl |
Writhing |
Fidgety |
Writhing |
Fidgety |
|||||
Prechtl et al [17] |
MN:32 RP: 58 ES: 40 |
FN: 70 FA: 16 F-: 44 |
MN: 0 RP: 8 ES: 36 |
FN: 0 FA: 6 F-: 43 |
49 |
– |
95% |
96% |
|
Ferrari et al [18] |
MN: 13 RP: 30 ES: 41 |
FN: 36 FA: 4 F-: 44 |
MN: 0 RP: 7 ES: 37 |
FN: 0 FA: 1 F-: 43 |
44 |
0,005 |
100% |
82% |
|
Brogna et al [21] |
MN: 472 RP: 74 ES: 28 |
FN: 535 FA: 11 F-: 28 |
MN: 0 RP: 5 ES: 17 |
FN: 0 FA: 0 F-: 22 |
22 |
< 0,001 |
100% |
86-97% |
|
Spittle et al [22] |
MN: 40 RP: 51 ES: 8 |
FN: 78 FA: 0 F-: 21 |
MN: 0 RP: 1 ES: 4 |
FN: 0 FA: 0 F-: 5 |
5 |
– |
100% |
84% |
|
Dimitrijevic et al [25] |
MN: 49 RP: 20 ES: 10 |
FN: 58 FA: 7 F-: 14 |
MN: 0 RP: 2 ES: 9 |
FN: 0 FA: 0 F-: 11 |
11 |
< 0,001 |
100% |
95,6% |
|
Seme-Ciglenecki et al [19] |
NV |
FN: 77 FA: 16 F-: 19 |
NV |
FN: 1 FA: 5 F-: 10 |
16 |
– |
87% |
89% |
|
Romeo et al [20] |
NV |
FN: 699 FA: 49 F-: 55 |
NV |
FN: 1 FA: 6 F-: 50 |
57 |
< 0,001 |
98% |
94% |
|
Øberg et al [24] |
NV |
FN: 54 FA: 16 F-: 17 |
NV |
FN: 0 FA: 1 F-: 9 |
10 |
– |
90% |
90% |
|
ES: espasmódicos-sincronizados; F-: fidgety ausente; FA: fidgety anormal; FN: fidgety normal; MN: movimiento normal; NV: no valorado; RP: repertorio pobre. |
General movement assessment as a tool for determining the prognosis in infantile cerebral palsy in preterm infants: a systematic review Introduction. Cerebral palsy is considered to be the main cause of physical disability in childhood. General movements are an assessment tool in order to predict the neurological and long-term outcome of the newborn. Aim. To analyze the current evidence on the general movements assessment in preterm infants as cerebral palsy prognostic tool. Subjects and methods. Systematic review following PRISMA statements. Databases consulted were: PubMed/Medline, Lilacs, IBECS, Cochrane, PEDro, Cinhal, Sport discuss, Phyinfo, Academic Search Complete, Web of Science, and SciELO. We included studies that evaluated general movements in the first 20 weeks premature newborns. We excluded studies where the sample submit other pathologies or medication was administered. Newcastle-Ottawa Scale was used to assessment the risk of bias. Results. Ten cohort studies form this review. 2243 premature, with an average of 30.9 weeks of gestation, were analyzed. General movements recording was carried out between 5 and 30 minutes. When there are abnormal general movements, the chances of neurological involvement increase during development, whereas when normal general movements are evaluated, there will rarely be a subsequent cerebral palsy diagnosis. Conclusions. The predictive validity of the preterm general movements assessment is confirmed as a tool to predict cerebral palsy early. Since preterm infants are more likely to trigger abnormal general movements, it is interesting to promote this type of assessment. Key words. Cerebral palsy. Child development. General movements assessment. Neurodevelopmental disorders. Neurologic examination. Premature newborns. |