Developmental Programming of Low Podocyte Endowment: A Risk Factor for Chronic Kidney Disease?

infants at risk of neurodevelopmental disability in order to intervene early and improve outcomes. Neonates who undergo major surgery are known to be at risk of poor neurodevelopment, however there is a paucity of data on the use of the General Movements Assessment GMA with this population, despite strong evidence for use of the GMA in other high risk groups. Methods: 278 infants who had undergone cardiac surgery (n=149, 54%), non-cardiac surgery (n= 123, 44%), or both surgeries (n=6, 2%) were assessed using the GMA at a mean age of 12 weeks (SD 1.6 weeks). Videos were independently rated by three clinicians, two blinded to clinical details. Multidisciplinary follow-up was at one year of age. Results: There were twenty-five infants with absent fidgety movements (9%), and fifteen of these demonstrated clinical signs of CP at one year of age. Another six had developmental delay, including three with severe delay. There was a significant difference in the developmental outcomes of these infants compared to those with normal fidgety movements, across all subtests of the Bayley Scales of Infant and Toddler Development (p<0.05). Of the 248 (89%) infants with normal fidgety movements, none had a diagnosis of CP at 12 months of age. Conclusions: The GMA has predictive value for CP in this unique population. It is a valid complementary assessment tool that should be incorporated into the multidisciplinary follow-up for infants following surgery in order to facilitate referral into specialised early intervention services.