“How could I apply this information?” This article reported the relationship between movement patterns and severity of perinatal hypoxic-ischemic encephalopathy (HIE) for 3to 5-month-old infants. Early detection of atypical movement helps identify children at risk for movement disorders, including cerebral palsy (CP).1 Detection of abnormal movement and rehabilitation in the first years of life afford an opportunity to maximize functional outcomes because of neuroplasticity in early development. Physical therapists are uniquely qualified to evaluate and analyze the motor repertoire of infants because of our expertise in the human movement system. Prechtlʼs General Movements Assessment (GMA) and associated Motor Optimality Score have previously been shown to have utility as predictors of neurologic outcome.2-4 The absence of fidgety movement at 3 to 5 months is of particular predictive value. Based on early detection criteria, infants with HIE have newborn-detectable risks for motor dysfunction and standardized motor assessment, such as the GMA, before 5 months is recommended.1 “What should I be mindful about when applying this information?” Early detection guidelines can be integrated into clinical practice.5 Pediatric physical therapists should be familiar with these guidelines for infants with newborn risk factors, including HIE. When therapists lack training in the GMA or in the absence of collaboration with a trained colleague, other assessments should be considered. The Hammersmith Infant Neurologic Assessment or the Test of Infant Motor Performance has established predictive validity. Training in these assessments is widely available. Early intervention should result from early detection of motor dysfunction. Intervention should target optimal function based on best evidence, including meaningful active movement at adequate dosing for use-dependent plasticity.6 Importantly, wide variability exists in access to such intervention.7 Collaborations that leverage diagnostic techniques, intervention skills, and resources may promote best outcomes for infants with HIE.

OBJECTIVE: The purpose of the current investigation was to describe the fine- and gross-motor acquisitions of very low birth weight (VLBW) infants during their first 12 months without imposing traditional assessment assumptions. STUDY DESIGN: A nonrandomized, prospective study was used for a sample consisting of 89 VLBW infants whose motor development was assessed neonatally and at 4, 8, and 12 months chronological age. Fine- and gross-motor assessment items were selected and adapted from three standardized assessment instruments. RESULTS: The fine- and gross-motor systems of development appeared to be relatively independent of one another before the 8-month assessment. Thus, early fine-motor control appeared to develop almost to the exclusion of gross-motor progress. Once fine-motor control was established by 8 months, numerous gross-motor milestones followed and were present at 12 months chronological age. CONCLUSION: Current and previous data continue to define a developmental picture in which VLBW and fullterm infants achieve the same fine- and gross-motor milestones; however, the developmental pathways whereby milestones are achieved, during at least the first 12 months, appear to be different. Accordingly, applying instruments standardized on fullterm infants to the assessment of VLBW babies may not be serving us well on a number of different issues.

Maternal Perception of Toddler Temperament: The Effect of Maternal and Infant Health or Illness during the Neonatal Period

NORMAL HEARING AND DEVELOPMENTAL OUTCOME FOR INFANTS WITH PPHN TREATED WITH MODERATE HYPERVENTILATION: A CONTROLLED STUDY. 1203

OBJECTIVE:To determine whether a significant relationship exists between the presence of apnea and the number of days it takes a premature infant to attain full oral feeding.DESIGN:A two-way analysis of variance factorial design (apnea x aminophylline) was used with infants grouped according to presence or absence of apnea and whether they were receiving aminophylline.SETTING:Neonatal intensive-care and step-down nurseries of a level III teaching hospital.PATIENTS/PARTICIPANTS:Eligibility criteria for this study included gestational age of 28-34 weeks, less than 48 hours of mechanical ventilation, and absence of congenital anomalies. Infants were classified into one of four groups: Group 1 (NN) consisted of infants who had no recorded apnea and were not receiving aminophylline (n = 27); group 2 (AA) consisted of infants receiving aminophylline who continued to experience apnea during the transition time to oral feeding, (n = 20); group 3 (NA) consisted of infants receiving aminophylline who did not experience apnea during the transition time to oral feeding (n = 12); and group 4 (AN) were infants who experienced some apnea but never received aminophylline (n = 6). All 65 enrolled subjects completed the study.PROCEDURES:Review of medical records and daily nursing notes to record apnea instances and oral feeding status for each 24-hour period.MAIN OUTCOME MEASURES:The number of days between the first attempted oral feeding and full oral feeding was recorded, as well as number of apnea instances occurring during the transition time.RESULTS:An analysis of variance procedure showed that groups who did not experience apnea had a significantly (F[1, 61] = 10.19, p < .01) shorter transition time (NN = 6.6 days, NA = 5.4 days) than groups who did (AA = 11.3 days, AN = 10.3 days). Apnea was found to be correlated strongly with transition time (R = .42, p < .001). A multiple linear regression forward selection procedure showed apnea to make the greatest contribution to variance in transition time in days with a partial R2 of .18 (p < .001).CONCLUSION:Apnea appears to be a factor that influences the length of time it takes a premature infant to begin receiving full oral feedings.