Socioeconomic level influences the early motor repertoire of infants at biological risk in a low- and middle-income country setting

Background Early neurodevelopment is shaped by biological and environmental factors. Prematurity, low birth weight, and socioeconomic adversity are linked to a higher risk of developmental impairments. The General Movements Assessment (GMA) is a reliable tool for early identification of infants at risk for neurodevelopmental impairment. Objectives To describe the early motor repertoire of infants followed in a neonatal follow-up clinic using the GMA and to investigate how clinical and socioeconomic factors influence motor outcomes during the first five months of life. A secondary objective was to characterize motor performance using the Motor Optimality Score–Revised (MOS-R). Methods This retrospective observational study included preterm and term infants at risk for developmental impairment, followed at the University Hospital of the University of São Paulo between March 2022 and February 2025. Videos recorded from term age to five months corrected age were analyzed using Prechtl's GMA and the MOS-R. Clinical and socioeconomic variables were examined using linear and logistic regression models. Results Seventy-four infants were included; 82.4% were born preterm and 73.0% had low birth weight (<2500 g). During the writhing-movements phase, 71.4% had a poor repertoire and 10.7% were cramped-synchronized. During the fidgety movements phase, 88.2% exhibited normal fidgety movements and 11.8% had absent fidgety movements. Among 45 infants assessed with the MOS-R, 75.6% had reduced motor optimality scores, with the Postural Patterns domain contributing most to this reduction. Higher family income was associated with higher MOS-R scores (β = 0.00067, p = 0.039). A poor repertoire was associated with lower birth weight (OR = 0.9972, p = 0.026) and lower gestational age (OR = 0.9371, p = 0.028). Conclusions Reduced motor optimality was common despite predominantly normal fidgety movements. Family income was associated with motor optimality in univariate analysis, a preliminary finding that suggests the importance of integrating standardized motor assessments and socioeconomic surveillance into neonatal follow-up programs.