Associations Between Early Structural MRI, Hammersmith Infant Neurological Exam, and General Movements Assessment in Very Preterm Infants

Objective To evaluate the prevalence and associations between structural MRI (sMRI) injury/abnormality at term equivalent age and absent fidgety General Movements Assessment (GMA) and abnormal Hammersmith Infant Neurological Examination (HINE) scores among very preterm infants at 3-4 months corrected age. Study design This prospective cohort study enrolled 392 infants born ≤ 32 weeks’ gestation from five neonatal intensive care units in the greater Cincinnati area between September 2016 and October 2019. Infants completed sMRI at term-equivalent age and GMA and HINE at 3-4 months corrected age. All assessors were blinded. Results Of 392 infants, 375 (96%) had complete data. Of these, 44 (12%) exhibited moderate or severe brain abnormalities, 17 (4.5%) had abnormal GMA, and 77 (20.3%) had abnormal HINE. Global and regional abnormality scores on sMRI were significantly correlated with GMA (R2 range: 0.05-0.17) and HINE at 3-4 months corrected age (R2 range: 0.01-0.17). These associations remained significant in multivariable analyses after adjusting for gestational age and sex. There was a significant but low correlation (R2 0.14) between GMA and HINE. Conclusion We observed a low prevalence of moderate or severe brain abnormalities in very preterm survivors in this geographically-defined cohort. The much higher prevalence of abnormal motor exam on the HINE compared with GMA and their low correlation suggests that these tests evaluate different constructs, and thus, should be used in combination with sMRI rather than interchangeably.