Background and aim: The early identification of the former premature neonates at risk of neurologic sequelae could lead to early intervention and a better prognosis. This pilot study aimed to investigate whether the General Movement patterns observed at term-equivalent age in former premature infants could serve as predictors for guiding early intervention and improving prognosis. Materials and methods: In a population of 44 premature neonates (mean gestational age 33.59 weeks (+2.43 weeks)) examined at term-equivalent age, 10 neonates with a cramped–synchronized General Movements motor pattern were identified. These neonates were included in an early intervention program consisting of physiotherapy executed both by the therapist and by the parents at home. They were again examined at a corrected age of 12 weeks. The presence or absence of fidgety movements and the MOS-R (motor optimality score revised) was noted. The examinations were performed by certified specialists. Results: Normal fidgety movements and a MOS-R of 20–24 were presented in 9/10 of the former premature infants, with normal foot to foot contact present in 7/10, and normal hand to hand contact present in 5/10. The atypical patterns noted were side to side movements of the head in 5/10, a non-centered head in 9/10, asymmetric tonic neck reflex in 9/10 and jerky movements in 10/10. One patient presented with no fidgety movements and a MOS-R score of 9. Conclusion: Early intervention in our group of patients allowed for an improvement in the neurologic status, demonstrated by the presence of fidgety movements. We suggest that early intervention should be indicated in all premature infants that present with a cramped–synchronized GM pattern during examination at term-equivalent age. However, due to the small sample size, the absence of statistical analysis and a control group, and the limited follow-up period, the conclusions must be approached with caution.

Background and aim: Our research aims to find correlations between the brain imaging performed at term-corrected age and the atypical general movement (GM) patterns noticed during the same visit a—cramped-synchronized (CS) or poor repertoire (PR)—in formerly premature neonates to provide evidence for the structures involved in the modulation of GM patterns that could be injured and result in the appearance of these patterns and further deficits. Materials and methods: A total of 44 preterm neonates ((mean GA, 33.59 weeks (+2.43 weeks)) were examined in the follow-up program at Life Memorial Hospital Bucharest at term-equivalent age (TEA). The GM and ultrasound examinations were performed by trained and certified specialists. Three GM pattens were noted (normal, PR, or CS), and the measurements of the following cerebral structures were conducted via head ultrasounds: ventricular index, the short and long axes of the lateral ventricles, the midbody distance of the lateral ventricle, the diagonal of the caudate nucleus, the width of the basal ganglia, the width of the interhemispheric fissure, the sinocortical width, the length and thickness of the callosal body, the anteroposterior diameter of the pons, the diameter of the vermis, and the transverse diameters of the cerebellum and vermis. The ultrasound measurements were compared between the groups in order to find statistically significant correlations by using the F_ANOVA test (significance p < 0.05). Results: The presence of the CS movement pattern was significantly associated with an increased ventricular index (mean 11.36 vs. 8.90; p = 0.032), increased midbody distance of the lateral ventricle–CS versus PR (8.31 vs. 3.73; p = 0.001); CS versus normal (8.31 vs. 3.34; p = 0.001), increased long and short axes of the lateral ventricles (p < 0.001), and decreased width of the basal ganglia–CS versus PR (11.07 vs. 15.69; p = 0.001); CS versus normal pattern (11.07 vs. 15.15; p = 0.0010). The PR movement pattern was significantly associated with an increased value of the sinocortical width when compared to the CS pattern (p < 0.001) and a decreased anteroposterior diameter of the pons when compared to both the CS (12.06 vs. 16.83; p = 0.001) and normal (12.06 vs. 16.78; p = 0.001) patterns. The same correlations were present when the subgroup of infants with a GA ≤ 32 weeks was analyzed. Conclusions: Our study demonstrated that there are correlations between atypical GM patterns (cramped-synchronized—CS and poor repertoire—PR) and abnormalities in the dimensions of the structures measured via ultrasound at the term-equivalent age. The correlations could provide information about the structures that are affected and could lead to a lack of modulation in the GM patterns.

Background/Objectives: Our research aimed to assess if correlations could be found between items evaluated at the cerebral ultrasound performed at term-equivalent age (TEA) and neuro-motor outcomes evaluated at 12 and 24 months of corrected age in a group of preterm infants. Methods: The following were assessed: the Levine Index, the diagonals of the lateral ventricles, the size of the ventricular midbody, the sinocortical distance, the width of the basal ganglia, the cortical depth at the level of the cingular sulcus and the maturation of the gyral folding. The neurologic evaluation was performed at 12 and 24 months of corrected age, according to the Amiel Tison neurologic examination, and the items from the calendar of motor acquisitions were used as outcome measures of the study—gross and fine motor subsets. The comparisons between the different groups were performed using the FANOVA test, with a statistically significant association for a p < 0.05. Results: The abnormal gross motor acquisitions at 12 months were significantly associated with an increased size of the ventricular midbody (p < 0.009) and a significantly decreased diameter of the basal ganglia (p < 0.011) on the TEA cerebral ultrasound. At 24 months, a significant association was found with increased size of the ventricular midbody (>10.33 mm) (p < 0.001), a decreased diameter of the basal ganglia (<12.9 mm) (p < 0.016), a decreased cortical depth (p < 0.021) and an immature gyral maturation pattern (p < 0.001). In the case of severely abnormal fine motor outcomes, at 12 months, there were statistically significant associations with an increased size of the ventricular midbody (p < 0.001) and an immature gyral folding pattern (p < 0.0180); at 24 months, significant associations were noted with the size of ventricular midbody (p < 0.001), a decreased diameter of the basal ganglia (p < 0.016), a decreased cortical depth (p < 0.021) and an immature gyration folding (p < 0.001). Conclusions: The abnormal gross and fine motor outcome in former premature infants at 12–24 months corrected age is significantly associated with abnormal findings in the head ultrasound examination performed at TEA reflecting both white matter (increased midbody distance) and grey matter (decreased diameter of the basal ganglia, decreased cortical depth and an immature gyration pattern) involvement.

Background and Objectives: Our quality management project aims to decrease by 20% the number of neonates with respiratory distress undergoing chest radiographs as part of their diagnosis and monitoring. Materials and Methods: This quality management project was developed at Life Memorial Hospital, Bucharest, between 2021 and 2023. Overall, 125 patients were included in the study. The project consisted of a training phase, then an implementation phase, and the final results were measured one year after the end of the implementation phase. The imaging protocol consisted of the performance of lung ultrasounds in all the patients on CPAP (continuous positive airway pressure) or mechanical ventilation (first ultrasound at about 90 min after delivery) and the performance of chest radiographs after endotracheal intubation in any case of deterioration of the status of the patient or if such a decision was taken by the clinician. The baseline characteristics of the population were noted and compared between years 2021, 2022, and 2023. The primary outcome measures were represented by the number of X-rays performed in ventilated patients per year (including the patients on CPAP, SIMV (synchronized intermittent mandatory ventilation), IPPV (intermittent positive pressure ventilation), HFOV (high-frequency oscillatory ventilation), the number of X-rays performed per patient on CPAP/year, the number of chest X-rays performed per mechanically ventilated patient/year and the mean radiation dose/patient/year. There was no randomization of the patients for the intervention. The results were compared between the year before the project was introduced and the 2 years across which the project was implemented. Results: The frequency of cases in which no chest X-ray was performed was significantly higher in 2023 compared to 2022 (58.1% vs. 35.8%; p = 0.03) or 2021 (58.1% vs. 34.5%; p = 0.05) (a decrease of 22.3% in 2023 compared with 2022 and of 23.6% in 2023 compared with 2021). The frequency of cases with one chest X-ray was significantly lower in 2023 compared to 2022 (16.3% vs. 35.8%; p = 0.032) or 2021 (16.3% vs. 44.8%; p = 0.008). The mean radiation dose decreased from 5.89 Gy × cm² in 2021 to 3.76 Gy × cm² in 2023 (36% reduction). However, there was an increase in the number of ventilated patients with more than one X-ray (11 in 2023 versus 6 in 2021). We also noted a slight annual increase in the mean number of X-rays per patient receiving CPAP followed by mechanical ventilation (from 1.80 in 2021 to 2.33 in 2022 and then 2.50 in 2023), and there was a similar trend in the patients that received only mechanical ventilation without a statistically significant difference in these cases. Conclusions: The quality management project accomplished its goal by obtaining a statistically significant increase in the number of ventilated patients in which chest radiographs were not performed and also resulted in a more than 30% decrease in the radiation dose per ventilated patient. This task was accomplished mainly by increasing the number of patients on CPAP and the use only of lung ultrasound in the patients on CPAP and simple cases.

Research on late preterm infants is limited compared with extremely low birth weight infants, despite their vulnerability to brain injury. Early intervention is crucial, as these infants often face higher risks of cerebral palsy and developmental delays. This review examines methods to predict neurological outcomes and evaluates standard care protocols for neurologically affected late preterm infants. It also explores the potential for developing a comprehensive care bundle that integrates family involvement and delineates the responsibilities for continuous developmental monitoring. A total of 21 studies, primarily cohort studies, were included. This review synthesizes recent research on neurological development in late preterm infants, highlighting key markers and methods to improve neurological monitoring and long-term outcomes. Late preterm infants are at an increased risk for neurodevelopmental impairments, such as cerebral palsy and cognitive delays, particularly when growth restrictions or low birth weight are present. Early interventions, including specialized neurological assessments and targeted rehabilitation, show potential for improving these outcomes. Late preterm infants face increased neurodevelopmental risks despite low perinatal mortality. Early identification, standardized assessments, and targeted follow-up are essential. Emerging interventions show promise, but further research and equitable care access are needed to improve long-term outcomes.

Background: Our study aimed to investigate whether the general movements assessment (GMA) and Amiel-Tison Neurologic Examination performed at term-equivalent age (TEA) and 12 weeks corrected age (CA) could predict the occurrence of cerebral palsy (CP) and delayed gross motor milestones in a sample of term and preterm infants and whether the predictive values could be increased by using the two examinations during the same visit. Methods: A total of 70 infants (62 preterm and 8 at term) were examined at TEA and 12 weeks CA using GMs (General Movements) and Amiel-Tison (AT) examinations. We determined the correlation between the results of the examinations and several selected items (scarf sign, popliteal angle, and axial tone) and neuromotor outcomes (presence of cerebral palsy (CP), independent sitting, and independent walking). We attempted to build binary logistic regression models using items from both examination techniques to assess whether the combined use of the two exams could have a better predictive value than using one technique alone. Results: We analyzed the entire group and, separately, the subgroup of preterm infants. For the whole group, there was a statistically significant correlation between the GM examinations at TEA and 12 weeks CA (p < 0.008) as well as between the results of GM and AT exams performed at TEA (p < 0.001) and 12 weeks CA (p < 0.001). The strongest individual predictor for CP in the whole group was the absence of fidgety movements at 12 weeks CA (AUC (Area Under the Curve) = 0.873; CI (confidence interval) 95%: 0.748–0.998; p < 0.001) and a non-optimal result at the synthesis of findings of AT exam at 12 weeks CA (AUC = 0.755; CI 95%: 0.617–0.892; p < 0.003). In the subgroup of 62 premature neonates, absent fidgety movements at 12 weeks CA (AUC = 0.925; CI 95%: 0.819–1.031; p < 0.001) and a non-optimal result in the synthesis of findings of AT exam at 12 weeks CA (AUC = 0.772; CI 95%: 0.620–0.924; p < 0.005) were statistically significant predictors for the risk of CP. In the case of delayed sitting and delayed/absent walking, absent fidgety movements and non-optimal results in the AT exam at TEA and 12 weeks CA were the strongest individual predictors in the whole group as well as in the subgroup of preterm infants. The following exploratory logistic regression models reached statistical significance: one model combining absent fidgety + abnormal scarf sign + abnormal popliteal angle at 12 weeks CA for CP in the whole group (p < 0.032) and preterm infants (p < 0.034) and for delayed sitting in preterm infants (p < 0.041) and a second model combining absent fidgety + abnormal scarf + abnormal popliteal + abnormal axial + abnormal synthesis for CP risk (p < 0.046) and delayed sitting (p < 0.001) in preterm infants at 12 weeks CA. Conclusions: The absence of fidgety movements at 12 weeks CA represented the strongest individual predictor for the occurrence of CP and delayed gross motor milestones in our sample, both in the whole group and the subgroup of preterm infants. The combination of GM and AT findings reached statistical significance for the detection of CP risk in the whole group and CP risk and delayed sitting in the subgroup of preterm infants. Due to sample size limitations, the results should be regarded with caution, and larger studies are needed before robust conclusions can be drawn.