Effects of different early intervention strategies guided by GMOS, PDMS-2, or their combination on motor outcomes in preterm infants with PIVH: a randomized trial.

Abstract

Objective: Periventricular-intraventricular hemorrhage (PIVH) is a common and serious complication in preterm infants, significantly increasing the risk of adverse neurodevelopmental outcomes. This study aimed to investigate whether early intervention programs guided by the General Movement Optimality Score (GMOS), the Peabody Developmental Motor Scales-2 (PDMS-2), or their combination, are associated with superior motor development in preterm infants with PIVH compared to standard care.

Methods: In this prospective, stratified, randomized controlled trial, 103 preterm infants (gestational age < 37 weeks) with PIVH were screened. After applying the inclusion and exclusion criteria, 75 infants were enrolled, stratified by hemorrhage severity, and randomly allocated to one of four intervention groups: a Control group receiving standard early intervention; a GMOS group receiving standard intervention plus GMOS-guided therapy; a PDMS-2 group receiving standard intervention plus PDMS-2-guided therapy; and a GMOS + PDMS-2 group receiving standard intervention plus therapy guided by both tools. The primary outcomes, Fine Motor Quotient (FMQ) and Gross Motor Quotient (GMQ), were assessed using the PDMS-2 at corrected age (CA) 6 and 12 months. GMOS and general movements (GMs) were also evaluated at CA 1 and 3 months.

Results: The four groups were comparable at baseline regarding key demographic and perinatal factors, major neonatal morbidities, clinical course, and initial neuromotor assessment scores (all p > 0.05). While no significant differences were observed at CA 3 months, the GMOS + PDMS-2 group demonstrated a significantly higher FMQ than the Control group at CA 6 months (median difference: 7.5 points, p = 0.006). By CA 12 months, significant differences emerged among the groups (p < 0.001 for both FMQ and GMQ), with large effect sizes (η² > 0.21). The GMOS + PDMS-2 group significantly outperformed both the Control group (FMQ median difference: 11.5 points; GMQ: 9.0 points; p < 0.001) and the GMOS-only group (FMQ: 9.0 points; GMQ: 7.0 points; p < 0.001).

Conclusion: A combined early intervention strategy, dynamically guided by both GMOS and PDMS-2, is associated with significantly superior motor outcomes at 12 months CA in preterm infants with mild PIVH compared to standard care or interventions guided by either tool alone, suggesting that this combined approach may represent a promising model for optimizing early motor outcomes at 12 months CA in this high-risk population.