Early detection of cerebral palsy in high‐risk infants: Translation of evidence into practice in an Australian hospital

Abstract

Aim The early diagnosis of cerebral palsy (CP) allows children timely access to early intervention. In 2018, Monash Children's Hospital established an Early Neurodevelopment Clinic based upon evidence‐based guidelines for the early diagnosis of CP in high‐risk infants. In this study, we aimed to characterise the infants presenting to the clinic and determine the rate of CP diagnosis. Methods This study analysed data from infants attending the Early Neurodevelopment Clinic between May 2019 and April 2020. Infants at high‐risk for CP attended the clinic at 3 months corrected age. Neuroimaging reports were reviewed, and a Prechtl's General Movement Assessment and Hammersmith Infant Neurological Examination were performed. Infants were diagnosed as having typical development, delayed development, high‐risk of CP or CP at the time of clinic attendance and referred on to the appropriate pathway. Results Ninety‐six high‐risk infants attended the clinic over the 1 year study period. Sixty‐eight (71%) infants were extremely preterm or extremely low birthweight, and 28 (29%) were infants at born at older gestation with evidence of moderate to severe brain injury. Nine (9.6%) infants received a CP diagnosis and 12 (12.5%) were considered high‐risk of CP. All infants with CP or high‐risk of CP were referred to the Victorian Paediatric Rehabilitation Service. Conclusions It is feasible to implement the early CP diagnosis guidelines into a high‐risk infant follow‐up clinic. Implementation of the guidelines allows for early diagnosis of CP and appropriate referral of high‐risk infants.

Age of Diagnosis, Fidelity and Acceptability of an Early Diagnosis Clinic for Cerebral Palsy: A Single Site Implementation Study

“…The proportion of infants in our clinic diagnosed with CP or high risk of CP (57%) was higher than a recently reported neurodevelopment follow up clinic (22% CP or high risk of CP [38]) and met our hypothesis. This difference probably reflects the specificity of our eligibility criteria.…”

The assessment of general movements in term and late-preterm infants diagnosed with neonatal encephalopathy, as a predictive tool of cerebral palsy by 2 years of age—a scoping review

“…For the age at which CP was diagnosed, 16 of the excluded studies used the same criteria as we did in this study, that is, CP diagnosis by at least 2–3 years [ 13 , 46 , 48 , 49 , 53 , 54 , 56 – 61 , 63 , 64 , 66 ]. For the method of CP diagnosis, a variety of standardized assessments were used, with the most frequent being by Amiel-Tison and Grenier [ 69 ] (5 of the 25) [ 13 , 47 , 54 , 60 , 63 ] and Touwen Infant Neurological Examination (TINE) [ 70 ] (5 of the 25) [ 46 , 47 , 49 , 54 , 64 ] with other assessments [ 71 – 81 ] detailed in Additional file 4 : Table 4.…”

“…Eight studies either used non-standardized methods or did not clearly state their method [ 45 , 50 , 51 , 56 , 57 , 59 , 62 , 65 ].…”

“…Negative predictive value was reported close to 98.31% [ 66 ] or at 100% [ 54 ]. Themes for the limitations identified by the authors can be summarized as limited external validity due to small population size [ 48 – 50 , 56 , 58 , 63 , 64 , 66 ] selection bias related to recruitment from high-risk populations [ 13 , 51 , 58 ], and practice variation between sites [ 45 , 54 , 57 ]. The most common reasons for the exclusion of these studies were failure to delineate their participants for the diagnosis of NE, most quoting their participants as high-risk infants, or not delineating their GA into the groups relevant to our questions (late-preterm and term) [ 45 , 49 – 54 , 57 , 58 , 60 , 62 – 66 ].…”

Wykorzystanie skali Hammersmith Infant Neurological Examination u niemowląt w celu przewidywania lub potwierdzenia wystąpienia mózgowego porażenia dziecięcego - systematyczny przegląd piśmiennictwa

“…Ostatecznie do przeglądu włączono i poddano szczegóło-wej analizie 14 publikacji wykorzystujących narzędzie HINE (Rycina 1). Dodatkowym narzędziem wykorzystanym przez część badaczy w swoich pracach była skala Bayley II [10,[15][16][17] oraz metoda oceny globalnych wzorców ruchowych według Prechtla [9,18]. Szczegółowe wyniki niniejszego przeglądu zostały przedstawione w formie tabelarycznej, uwzględniając cel badania, charakterystykę grup badanych, interwencję terapeutyczną oraz wyniki (Tabela I).…”