Early Assessment Fairly Accurate for Flagging Cerebral Palsy

Early neurodevelopmental assessments effectively identified infants with cerebral palsy and predicted its severity in extremely small or preterm infants and those with encephalopathy, according to a study adding real-world support to prior findings.

Among 116 infants, the accuracy of diagnosis of cerebral palsy or high risk of cerebral palsy at a corrected age of 3 to 4 months was 85% (95% CI 77-91) overall and 81% (95% CI 73-88) for predicting moderate-to-severe cases when compared with results at 24 to 36 months’ corrected age, reported Abdul Razak, MD, of Monash University in Melbourne, Australia, and colleagues.

However, when it came to predicting cognitive impairment, the accuracy of early neurodevelopmental assessments was “notably limited,” ranging from 44% to 60%, the authors wrote in JAMA Network Open. The findings were also presented at the Pediatric Academic Societies meeting in Toronto.

Prior studies using observational data had supported feasibility of early neurodevelopmental assessments for diagnosing cerebral palsy at an early stage, but they hadn’t directly compared early data with long-term outcomes, Razak and colleagues noted.

The real-world setting was important, Razak told MedPage Today in an email. “Our study supports adaptability of these assessments in clinical practice worldwide.”

“Incorporating these assessments to pick up cerebral palsy as early as 3 to 4 months is a game changer, as we may be able to change the neurodevelopmental trajectories of these babies,” he said.

Diagnosis of early cerebral palsy or high risk of cerebral palsy — based on absent fidgety movements, a low score on the Hammersmith Infant Neurological Examination (HINE <57), and medical neurological examination — demonstrated a sensitivity of 92% (95% CI 63-99) and specificity of 84% (95% CI 76-90) for predicting cerebral palsy, Razak and colleagues reported.

The criteria further demonstrated 100% (95% CI 59-100) sensitivity and 80% (95% CI 72-87) specificity for predicting moderate-to-severe cerebral palsy.

Findings also included that the absence of fidgety movements showed an 81% (95% CI 73-88) accuracy in predicting cerebral palsy and that HINE scores “displayed good discriminatory power,” with an area under the curve of 0.88 (95% CI 0.79-0.97) for predicting cerebral palsy, Razak and colleagues noted.

As for predicting cognitive impairment and its severity, “[a]lthough the specificity of certain assessments showed modest values, ranging between 76% and 80%, the sensitivity and positive and negative predictive values demonstrated suboptimal performance,” Razak and colleagues wrote. The HINE score also “displayed limited discriminatory power” in predicting cognitive impairment, with an area under the curve of 0.62 (95% CI 0.51-0.73), they noted.

For neurodevelopmental impairment (NDI), early assessment correctly identified all infants with cerebral palsy but also yielded false positives, resulting in a lower accuracy of 48% (95% CI 38-57). Predictive accuracy of various early neurodevelopmental assessments was “notably low,” ranging from 31% to 59% for predicting NDI and its severity, the researchers added. Sensitivity and negative predictive values were “suboptimal” across the different assessments, while the positive predictive value and specificity were “modest.”

Razak and colleagues conducted their study at Monash Children’s Hospital in Melbourne, assessing all extremely preterm infants born at less than 28 weeks’ gestation, extremely low birth weight infants of less than 1,000 g, and term encephalopathic infants who received therapeutic hypothermia from January 1, 2019, through July 30, 2021.

Early neurodevelopmental assessments were conducted at a median of 13 weeks of age, and long-term neurodevelopmental outcome evaluations were conducted at a median of 33 months of age.

Overall, the prevalence of cerebral palsy was 11%, with 8% occurring among preterm infants and 31% among term infants with hypoxic-ischemic encephalopathy (HIE).

The prevalence of cognitive impairment was 64%, with 60% observed among preterm infants and 87% among term infants with HIE.

Limitations of the study included its relatively small size and that data were sourced from a single center, Razak and colleagues noted.

Also, because most of the infants studied were born extremely preterm, “findings may not be directly applicable to a more diverse range of infant populations,” they added.

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