La motricité spontanée du nouveau-né comme outil diagnostique et son rôle dans la prise en charge précoce

The neurological assessment of the newborn infant is fundamental to early diagnosis and prognosis, intensive monitoring, and treatment programs. The clinician can take advantage of a wide range of protocols, the majority of which are based on muscular tone and reflexes, but active and spontaneous behavior is increasingly taken into account, proceeding from the seminal work done by Prechtl, Brazelton and other authors in the seventies and eighties. Prechtl's method on the assessment of General Movements (GMs) is a standardized protocol for the recording, observation and qualitative judgement of spontaneous motor activity, suitable for the preterm as well as the full-term newborn infant from the preterm period up to 24 weeks of post-term age. The method has a very high predictive value for the major disorders of motor development, in particular cerebral palsy, with both sensitivity and specificity above 90%. But GMs are also predictive for minor neurological, cognitive and relational disorders. Recently, tight and specific relationships have been shown between GMs quality and structural anomalies found on neonatal neuroimaging. The importance of GMs in clinical practice is not restricted to evaluation: this is an approach that teaches us to observe without excessive manipulation, to respect age-specific functional competences, to pay attention to spontaneous activity as a potential repertoire, from which the most effective patterns can be selected, reinforced and adapted.