Masters Degrees (Physiotherapy)

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Browsing Masters Degrees (Physiotherapy) by browse.metadata.advisor "Du Preez, J. C. F."

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    The trajectory of general movements from birth until 12-14 weeks corrected age in preterm infants born before 33 weeks' gestation and weighing less than 1500g : a descriptive study
    (Stellenbosch : Stellenbosch University, 2019-04) Van Zyl, Reze; Burger, M.; Du Preez, J. C. F.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY : Background: Preterm infants remains a high risk group for developing neurological deficits such as cerebral palsy (CP). Early identification is important for timely intervention. Tygerberg Children’s Hospital (TCH) is a public hospital with limited resources. It is the biggest neonatal service in the Western Cape. Clinicians depend on a reliable screening method to identify high risk infants in order to allocate resources effectively. Prof. Heinz Prechtl and his co-workers introduced a quick, inexpensive, non-invasive method with high predictive validity for the early detection of those premature infants at risk for later developmental deficits. This method, called general movements (GMs), is based on the assessment of spontaneous movement patterns in young infants. There is limited information available describing the trajectory of GMs in high risk premature infants. Oojective: To describe the trajectories of GMs from birth till 12-14 weeks corrected age and determine the association of known perinatal risk factors on GM trajectories in very low birth weight and extremely low birth weight preterm infants admitted to the neonatal intensive care unit of TCH, Cape Town, South Africa. Methodology: A longitudinal, prospective cohort study with repeated measures was conducted using Prechtl’s method of the qualitative assessment of GMs at the following four key time periods: birth to 33 weeks postmenstrual age (PMA), 34-37 weeks PMA, term age and 12-14 weeks corrected age. Detailed perinatal data of infants were collected. Results were analysed using STATA version 14, IBM SPSS and a logistic regression model to determine the association between perinatal factors and GM outcome. Results: The study sample consisted of 119 infants with a mean birth weight of 1048.2g and a mean gestational age of 28.6 weeks. Of 300 GM assessments done, 157 were preterm assessments, 55 at term age and 88 at 12-14 weeks corrected age. At birth to 33 weeks PMA, 96% of GMs were abnormal and 4% normal. At 34-37 weeks PMA, 89% of GMs were abnormal and 11% normal. All GMs were abnormal at term age. At 12- 14 weeks corrected age, 7% of GMs were abnormal and 93% normal. On univariable analysis, lower birth weight (p=0.043), lower gestational age (p=0.017), intraventricular haemorrhage (IVH) grade IV (p<0.001) and time (PMA in weeks) (p<0.001) were associated with abnormal GMs. Birth weight (p=0.046) and time (PMA in weeks) (p<0.001) were the only variables inversely associated with abnormal GMs on multivariable analysis. Conclusion: The results of this study indicated that GMs are predominantly abnormal prior to term age with a significant decrease in abnormality at 12-14 weeks corrected age. Assessment of preterm and term GM trajectories does not necessarily enable earlier identification of infants at risk for neurodevelopmental difficulties. It is thus not advised that resources be allocated to conduct preterm and term GM trajectories at TCH. Lower birth weight and lower PMA (time) were associated with increased odds for abnormal GMs. Infants with a lower birth weight should be targeted for more frequent follow up and neurological assessments as they remain the most at risk group for neurological deficits. Research on GM trajectories prior to term age and the association of risk factors with long term neurodevelopmental outcome is necessary for future comparison.