Cerebral palsy diagnosis and the impact on hip surveillance enrollment

Abstract

Cerebral palsy (CP) is an umbrella term used to describe all non-progressive disorders of movement and posture attributed to disturbances that occurred in the developing fetal and infant brain. 1 This includes all non-progressive disturbances occurring in the prenatal, perinatal, and postnatal period, up to age 2 years. 1 Diagnosis is based on clinical signs and symptoms, medical history, and neuroimaging; it is not defined by the underlying cause of the condition. 2 Possible etiologies of CP include, but are not limited to, preterm birth, congenital brain malformations, infections, intraventricular hemorrhage, and genetic abnormalities. 3 Frequently, the etiology of a child's CP is unknown. 4 A diagnosis of CP is often the first step for families to access CP-specific resources. The minimum age at which a valid and reliable diagnosis of CP can be given is controversial. 5 Traditionally, CP has been diagnosed between 12 and 24 months. 1,2,6 Recent evidence has suggested that this diagnosis can be accurately made before 6 months of age. 2 Delaying diagnosis may negatively impact developmental progress, access to services, such as hip surveillance and psychological support for parents, and prevention of secondary complications. 2,7,8 To avoid delay, an interim clinical diagnosis of high risk of CP is recommended until a diagnosis is confirmed. 2 Hip surveillance is now considered standard of care for children with CP. 9 Established surveillance programs allow for early identification of hip displacement and optimally timed orthopaedic intervention to prevent hip