Effects of Early Physiotherapy Program on the Infants in NICU

Prechtl's General Movements (GMs) Assessment: General movements (GMs) are the spontaneous movement repertoire present from early fetal life until the 20th week postpartum. They are "writhing" until the 8th week postpartum and then "fidgety" until approximately the 20th week. Heinz Prechtl demonstrated the validity and reliability of this method by determining that infants without fidgety movements between 3 and 5 months of age are at high risk of developing CP. Video recordings will begin in the NICU 3 days after birth during the preterm period. All infants will be examined for writhing and fidgety movements (FM) using the video recordings. Movements during the preterm and writhing periods will be classified as PR, CS, and Ch GMs or normal. Movements during the fidgety period will be recorded as F+ or F++ when normal, AF when abnormal, or F- when not observed. Motor optimality scores will also be calculated for all infants during the fidgety period.

The HINE is a simple, standardized, and scoreable test for the clinical neurological assessment of infants aged 2-24 months. It consists of three sections: (1) a neurological examination that assesses cranial nerve function, posture, movements, tone, reflexes, and reactions; (2) motor milestones; and (3) behavior. Each of the 26 items on the test is first scored individually (0, 1, 2, 3, or half-point). A total score is then calculated, with a maximum score of 78. The total score is classified as optimal or suboptimal. Optimal scores are based on the frequency distribution of neurological findings in the population observed in at least 90% of infants in the age range studied. Higher scores indicate better neurological status.

The BSID-III is a neurocognitive assessment used to monitor the development of infants aged 0-42 months. It has five domains: cognitive, language, motor, social-emotional, and adaptive functions. This study will assess only the first three domains. Cognitive, language, and fine and gross motor skills will be assessed. A composite score is calculated for each domain (mean 100±15). A composite score below 2 standard deviations (SD) (<70) is considered a severe delay across all domains.

Prenatal/perinatal risks (MRI, cUS results, diagnosis, neurological evaluation) of all infants and their parents will be obtained from hospital records after treatment.

The examination developed by Dubowitz standardized optimality scores by evaluating low-risk term and high-risk preterm infants at term age. The scale consists of a 34-item proforma. This proforma includes tone (10), tone patterns (5), reflexes (6), movements (3), abnormal signs (3), and behavior (7). All items are scored from 1 to 3 (half points are also possible). Higher scores indicate better neurological status.

Birth weight in kilograms, height in meters will be recorded. Weight and height will be combined to report BMI in kg/m2.