Follow-Up Corner: Moving Toward Earlier Diagnosis of Cerebral Palsy
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Neonatology UpdatePublished on
Neonatology Update
Hallam Hurt, MD, Education Director, Neonatal Follow-up Program
Historically, the diagnosis of cerebral palsy (CP) occurs at ~ 18 months of age. The current endeavor seeks to identify CP as early as 3 months of age and certainly before 6 months corrected age. Why? The impetus is to intervene during the period of neuroplasticity, which is greatest in early infancy. The overarching aim of early detection is provision of optimal developmental trajectories for children with interventions targeted not only to motor skills, but also to vision, hearing, sensory, pain, and sleep issues.
What tools are utilized to provide early detection?
History: birth history, course in the intensive care nursery
Imaging: results of cranial ultrasounds or MRI if available
Neurological Examination: findings on an examination conducted in neonatal follow-up clinic or primary care office
As reported in JAMA Pediatrics in 2017, the 3 tools with the best predictive validity for detecting CP before 5 months corrected age are:
Currently in CHOP Neonatal Follow-up Programs we utilize the HINE. Based on tools described above we identify some infants as at “high risk for CP” as early as 3-4 months, with future evaluations to confirm the diagnosis or not. The CP early detection initiative at CHOP follow-up clinics is being spearheaded by Andrea Duncan, MD, site investigator for this Cerebral Palsy Foundation sponsored endeavor.
Communicating the diagnosis of cerebral palsy to parents and families is a conversation that must be carried out with honesty and compassion. The following points regarding conduct of this communication were made at the Implementation of Early Detection and Intervention for Cerebral Palsy Conference in Spring 2018, and form the basis of our communication strategy.
Contributed by: Hallam Hurt, MD