New Screening Tool for Term-Born Infants Enables Update to the Clinical Practice Guideline for Early Diagnosis of Cerebral Palsy

Abstract

Rouabhi et al 1 present a novel prognostic tool for identifying the risk of cerebral palsy (CP) in a "low-risk" term newborn, using a large sample of population register data from Canadian infants. Selected clinical variables based on published risk factors were used to build and test a model. Variables not contributing to the model were removed, enabling development of a streamlined prognostic tool. The authors identified 12 clinical variables for inclusion within the tool, all of which are routinely collected clinical information about pregnancy and maternal history (eg, preeclampsia, tobacco use), labor and delivery history (eg, prolonged rupture of membranes, Apgar scores), and infant characteristics (eg, sex, birth weight). The tool calculates a prediction value for risk of CP and gives corresponding ranges from lower than normal to much higher than normal. Importantly, there are recommendations for the additional screening needed at each risk range. This enables streamlined resource use, from routine developmental screening by primary care professionals to referral for specialized assessments such as the General Movements Assessment (GMA) and Hammersmith Neurological Examination (HINE). Term infants with highest risk for CP (those with neonatal encephalopathy and seizures) were not included in the model as it was assumed these infants meet criteria for routine developmental screening as per clinical guideline recommendations. 2 Early screening for CP, the most common physical disability of childhood, has received significant attention over the last 5 years following publication of the International Clinical Practice Diagnostic Guidelines. 2 A large, matched case-control study subsequently demonstrated more than 97% predictive accuracy when 3 gold-standard tools' (Brain Magnetic Resonance Imaging; GMA; and HINE) scores all triangulate to indicate CP. 3 Early and accurate diagnosis of CP before 12 months of age is now well established to be both possible and feasible in realworld settings based on screening high-risk populations. 4,5 Earlier diagnosis expedites access to earlier CP-specific intervention with aims of optimizing infant neuroplasticity, preventing complications, and enhancing parent and caregiver well-being. 6 However, over 50% of children with CP are born at term, meaning many have no readily identifiable neonatal risk factors, 7 making early diagnosis of these infants a major challenge. 2 A case-control study previously identified that research on term-born singletons with CP not admitted to neonatal intensive care units (NICUs) was scarce but showed that almost 40% of the cases were not admitted to the NICU or special care and were considered neurologically normal at discharge. 8 The implications are that these "neurologically normal" infants are not referred to "high-risk" follow-up services and consequently diagnosis for these children occurs even later, often prompted by parental concerns. Late diagnosis of Related article page 177Editorial Opinion jamapediatrics.com (Reprinted) JAMA

Reliability, Knowledge Translation, and Implementability of the Spanish Version of the Hammersmith Infant Neurological Examination

“…Despite the lack of epidemiological registers in Spain [2], it is estimated that there are significant differences between Spanish regions attributed to a disparity in diagnostic practices, especially at an early age [3]. This may lead to a delayed follow-up of the "high-risk population for CP" and late referral to early intervention services [4,5].…”