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Peyton C, Aaby D, Barbosa VM, Boswell L, de Regnier RA, Bos AF, Sukal Moulton T. Baby Observational Selective Control AppRaisal (BabyOSCAR): Scores at 3 months predict functional ability, spastic cerebral palsy distribution, and diagnosis at 2 years. Dev Med Child Neurol 2024; 66:1521-1528. [PMID: 38629475 DOI: 10.1111/dmcn.15925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 02/15/2024] [Accepted: 03/06/2024] [Indexed: 10/04/2024]
Abstract
AIM To assess the predictive capabilities of the Baby Observational Selective Control AppRaisal (BabyOSCAR) tool, administered at 3 months corrected age, in determining spastic cerebral palsy (CP) outcome, functional abilities, and body topography at 2 years of age or later. METHOD Independent joint motions were measured at age 10 to 16 weeks from video recordings of spontaneous movement using BabyOSCAR in a sample of 75 infants. All included infants had known 2-year outcomes (45 with spastic CP and 30 without CP) including Gross Motor Functional Classification System (GMFCS) levels and CP body distribution. Receiver operating characteristic curves and cut points indicating greatest sensitivity and specificity were generated for predictive performance. RESULTS Total BabyOSCAR score was a strong predictor of future outcome of spastic CP (cut score of 22.5, sensitivity = 98%, specificity = 100%, area under the curve = 0.99), and was able to distinguish children classified in GMFCS levels I and II from those in III to V (cut score of 13.5, sensitivity = 92%, specificity = 89%, area under the curve = 0.94). Having an (absolute) asymmetry score on the BabyOSCAR of more than 5 was a predictor of having unilateral CP at age 2 years (sensitivity = 56%, specificity = 100%, area under the curve = 0.86). INTERPRETATION BabyOSCAR scores are predictors of diagnosis, body distribution, and future gross motor function in infants with spastic CP at 2 years of age or later. WHAT THIS PAPER ADDS Decreased independent joint movement at 3 months predicts spastic cerebral palsy (CP) at 2 years. Baby Observational Selective Control AppRaisal (BabyOSCAR) scores ≤13 are predictive of Gross Motor Function Classification System (GMFCS) levels III to V. BabyOSCAR scores of 14 to 22 are predictive of GMFCS levels I and II. A BabyOSCAR total asymmetry score >5 predicts unilateral CP. Stereotyped movements are more prominent in those who will be diagnosed with spastic CP at 2 years.
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Affiliation(s)
- Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David Aaby
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Lynn Boswell
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Raye-Ann de Regnier
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Theresa Sukal Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Kim F, Maitre N. Grand Rounds: How Do We Detect Cerebral Palsy Earlier in Neonates? J Pediatr 2024; 276:114299. [PMID: 39277080 DOI: 10.1016/j.jpeds.2024.114299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/27/2024] [Accepted: 09/09/2024] [Indexed: 09/17/2024]
Affiliation(s)
- Faith Kim
- Department of Pediatrics, Columbia University Irving Medical Center/New York-Presbyterian Children's Hospital of New York, New York, NY.
| | - Nathalie Maitre
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
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Romeo DM, Velli C, Sini F, Pede E, Cicala G, Cowan FM, Ricci D, Brogna C, Mercuri E. Neurological assessment tool for screening infants during the first year after birth: The Brief-Hammersmith Infant Neurological Examination. Dev Med Child Neurol 2024; 66:1173-1180. [PMID: 38287208 DOI: 10.1111/dmcn.15871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/31/2024]
Abstract
AIM To develop a short version of the original Hammersmith Infant Neurological Examination (HINE) to be used as a screening tool (Brief-HINE) and to establish if the short examination maintains good accuracy and predictive power for detecting infants with cerebral palsy (CP). METHOD Eleven items were selected from the original HINE ('visual response'; 'trunk posture'; 'movement quantity'; 'movement quality'; 'scarf sign'; 'hip adductor angles'; 'popliteal angle'; 'pull to sit'; 'lateral tilting'; 'forward parachute reaction'; 'tendon reflexes') identifying those items previously found to be more predictive of CP in both low- and high-risk infants. In order to establish the sensitivity of the new module, the selected items were applied to existing data, previously obtained using the full HINE at 3, 6, 9, and 12 months, in 228 infants with typical development at 2 years and in 82 infants who developed CP. RESULTS Brief-HINE scores showed good sensitivity and specificity, at each age of assessment, for detecting infants with CP. At 3 months, a score of less than 22 was associated with CP with a sensitivity of 0.88 and a specificity of 0.92; at 6, 9, and 12 months, the cut-off scores were less than 25 (sensitivity 0.93; specificity 0.87), less than 27 (sensitivity 0.95; specificity 0.81), and less than 27 (sensitivity 1; specificity 0.86) respectively. The presence of more than one warning sign, or items that are not optimal for the age of assessment, imply the need for a full examination reassessment. INTERPRETATION These findings support the validity of the Brief-HINE as a routine screening method and the possibility of its use in clinical practice.
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Affiliation(s)
- Domenico M Romeo
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Paediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Chiara Velli
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Sini
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisa Pede
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Paediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Graziamaria Cicala
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Daniela Ricci
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients-International Agency for the Prevention of Blindness (IAPB) Italia Onlus, Rome, Italy
| | - Claudia Brogna
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio Mercuri
- Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Paediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
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Ryll UC, Kembe J, Verhage CH, Sgandurra G, Krumlinde-Sundholm L, Eliasson AC. The Screening Hand Assessment for Infants for detecting the risk of unilateral cerebral palsy: Item selection and development. Dev Med Child Neurol 2024. [PMID: 38978330 DOI: 10.1111/dmcn.16004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 07/10/2024]
Abstract
AIM To develop a screening tool (the screening Hand Assessment for Infants [s-HAI]) for infants aged from 3.5 months that can identify a high risk of developing unilateral cerebral palsy (CP) based on a selection of items from the HAI. METHOD Receiver operating characteristic curve analysis was performed on previously collected HAI assessments from 212 infants (104 females, 108 males) aged from 3.5 to 8.5 months, to select items suitable for screening. The area under the curve (AUC), sensitivity, specificity, and cut-off values were derived for the suggested item combination. The clinical outcome (unilateral CP yes or no) at 24 months or older served as the external criterion. RESULTS About half of the infants developed unilateral CP. The AUC across the items ranged from 0.63 to 0.80, and from 0.85 to 0.87 for different item combinations. Sensitivity for the selected 6-item set was 91% for 8 points or less and 88% for 7 points or less on the contralesional score of each hand, while specificity was 60% and 73% respectively. INTERPRETATION The s-HAI, designed from six HAI items, has the potential to be used to screen infants at risk of unilateral CP from 3.5 months of age. It is easy to administer, time-efficient, and can be used in different settings. Its measurement properties and feasibility need to be tested in a new data set.
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Affiliation(s)
- Ulrike C Ryll
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Johanna Kembe
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Cornelia H Verhage
- Center for Child Development and Exercise, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Giuseppina Sgandurra
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Developmental Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Stella Maris, Pisa, Italy
| | | | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Luke C, Mick-Ramsamy L, Bos AF, Benfer KA, Bosanquet M, Gordon A, Williams H, Taifalos C, Smith M, Leishman S, Oakes E, Kentish M, McNamara L, Ware RS, Boyd RN. Relationship between early infant motor repertoire and neurodevelopment on the hammersmith infant neurological examination in a developmentally vulnerable First Nations cohort. Early Hum Dev 2024; 192:106004. [PMID: 38636257 DOI: 10.1016/j.earlhumdev.2024.106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
AIM To implement a culturally-adapted screening program aimed to determine the ability of infant motor repertoire to predict early neurodevelopment on the Hammersmith Infant Neurological Examination (HINE) and improve Australian First Nations families' engagement with neonatal screening. METHODS A prospective cohort of 156 infants (55 % male, mean (standard deviation [SD]) gestational age 33.8 (4.6) weeks) with early life risk factors for adverse neurodevelopmental outcomes (ad-NDO) participated in a culturally-adapted screening program. Infant motor repertoire was assessed using Motor Optimality Score-revised (MOS-R), captured over two videos, 11-13+6 weeks (V1; <14 weeks) and 14-18 weeks (V2; ≥14 weeks) corrected age (CA). At 4-9 months CA neurodevelopment was assessed on the HINE and classified according to age-specific cut-off and optimality scores as; developmentally 'on track' or high chance of either adverse neurodevelopmental outcome (ad-NDO) or cerebral palsy (CP). RESULTS Families were highly engaged, 139/148 (94 %) eligible infants completing MOS-R, 136/150 (91 %), HINE and 123 (83 %) both. Lower MOS-R at V2 was associated with reduced HINE scores (β = 1.73, 95 % confidence interval [CI] = 1.03-2.42) and high chance of CP (OR = 2.63, 95%CI = 1.21-5.69) or ad-NDO (OR = 1.38, 95%CI = 1.10-1.74). The MOS-R sub-category 'observed movement patterns' best predicted HINE, infants who score '4' had mean HINE 19.4 points higher than score '1' (95%CI = 12.0-26.9). Receiver-operator curve analyses determined a MOS-R cut-off of <23 was best for identifying mild to severely reduced HINE scores, with diagnostic accuracy 0.69 (sensitivity 0.86, 95%CI 0.76-0.94 and specificity 0.40, 95 % CI 0.25-0.57). A trajectory of improvement on MOS-R (≥2 point increase in MOS-R from 1st to 2nd video) significantly increased odds of scoring optimally on HINE (OR = 5.91, 95%CI 1.16-29.89) and may be a key biomarker of 'on track' development. INTERPRETATION Implementation of a culturally-adapted program using evidence-based assessments demonstrates high retention. Infant motor repertoire is associated with HINE scores and the early neurodevelopmental status of developmentally vulnerable First Nations infants.
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Affiliation(s)
- Carly Luke
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia; Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
| | - Leeann Mick-Ramsamy
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Arend F Bos
- General Movements Trust, Beatrix Children's Hospital, Division of Neonatology, University of Groningen, Groningen, the Netherlands
| | - Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Margot Bosanquet
- Department of Health and Wellbeing, Townsville Hospital and Health Service District (THHS), Townsville, Australia
| | - Anya Gordon
- Townsville University Hospital (TUH), Townsville Hospital and Health Service District (THHS), Townsville, Australia
| | - Hailey Williams
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Chloe Taifalos
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Maria Smith
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Shaneen Leishman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Ellena Oakes
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Megan Kentish
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Lynda McNamara
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
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Tran HTT, Le HT, Tran DM, Nguyen GTH, Hellström-Westas L, Alfven T, Olson L. Therapeutic hypothermia after perinatal asphyxia in Vietnam: medium-term outcomes at 18 months - a prospective cohort study. BMJ Paediatr Open 2024; 8:e002208. [PMID: 38388007 PMCID: PMC10882320 DOI: 10.1136/bmjpo-2023-002208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
AIM To determine neurodevelopmental outcome at 18 months after therapeutic hypothermia for hypoxic-ischaemic encephalopathy (HIE) infants in Vietnam, a low-middle-income country. METHOD Prospective cohort study investigating outcomes at 18 months in severely asphyxiated outborn infants who underwent therapeutic hypothermia for HIE in Hanoi, Vietnam, during the time period 2016-2019. Survivors were examined at discharge and at 6 and 18 months by a neonatologist, a neurologist and a rehabilitation physician, who were blinded to the infants' clinical severity during hospitalisation using two assessment tools: the Ages and Stages Questionnaire (ASQ) and the Hammersmith Infant Neurological Examination (HINE), to detect impairments and promote early interventions for those who require it. RESULTS In total, 130 neonates, 85 (65%) with moderate and 45 (35%) with severe HIE, underwent therapeutic hypothermia treatment using phase change material. Forty-three infants (33%) died during hospitalisation and in infancy. Among the 87 survivors, 69 (79%) completed follow-up until 18 months. Nineteen children developed cerebral palsy (8 diplegia, 3 hemiplegia, 8 dyskinetic), and 11 had delayed neurodevelopment. At each time point, infants with a normal or delayed neurodevelopment had significantly higher ASQ and HINE scores (p<0.05) than those with cerebral palsy. CONCLUSION The rates of mortality and adverse neurodevelopment rate were high and comparable to recently published data from other low-middle-income settings. The ASQ and HINE were useful tools for screening and evaluation of neurodevelopment and neurological function.
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Affiliation(s)
- Hang Thi Thanh Tran
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Neonatal Care Center, Vietnam National Children's Hospital, Ha Noi, Viet Nam
| | - Ha Thi Le
- Neonatal Care Center, Vietnam National Children's Hospital, Ha Noi, Viet Nam
| | | | | | | | - Tobias Alfven
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Linus Olson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Hidalgo Robles Á, Paleg GS, Livingstone RW. Identifying and Evaluating Young Children with Developmental Central Hypotonia: An Overview of Systematic Reviews and Tools. Healthcare (Basel) 2024; 12:493. [PMID: 38391868 PMCID: PMC10887882 DOI: 10.3390/healthcare12040493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
Children with developmental central hypotonia have reduced muscle tone secondary to non-progressive damage to the brain or brainstem. Children may have transient delays, mild or global functional impairments, and the lack of a clear understanding of this diagnosis makes evaluating appropriate interventions challenging. This overview aimed to systematically describe the best available evidence for tools to identify and evaluate children with developmental central hypotonia aged 2 months to 6 years. A systematic review of systematic reviews or syntheses was conducted with electronic searches in PubMed, Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews, Google Scholar, and PEDro and supplemented with hand-searching. Methodological quality and risk-of-bias were evaluated, and included reviews and tools were compared and contrasted. Three systematic reviews, an evidence-based clinical assessment algorithm, three measurement protocols, and two additional measurement tools were identified. For children aged 2 months to 2 years, the Hammersmith Infant Neurological Examination has the strongest measurement properties and contains a subset of items that may be useful for quantifying the severity of hypotonia. For children aged 2-6 years, a clinical algorithm and individual tools provide guidance. Further research is required to develop and validate all evaluative tools for children with developmental central hypotonia.
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Affiliation(s)
| | - Ginny S Paleg
- Physical Therapist, Montgomery County Infants and Toddlers Program, Rockville, MD 20825, USA
| | - Roslyn W Livingstone
- Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada
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Hidalgo-Robles Á, Merino-Andrés J, Rodríguez-Fernández ÁL, Gutiérrez-Ortega M, León-Estrada I, Ródenas-Martínez M. Reliability, Knowledge Translation, and Implementability of the Spanish Version of the Hammersmith Infant Neurological Examination. Healthcare (Basel) 2024; 12:380. [PMID: 38338265 PMCID: PMC10855046 DOI: 10.3390/healthcare12030380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Purpose. This study aimed to: (a) translate and cross-culturally adapt the Hammersmith Infant Neurological Examination (HINE) into Spanish; (b) evaluate its intra- and inter-examiner reliability; (c) support a knowledge translation and tool implementation program in early intervention; and (d) evaluate its reliability and implementation for professionals one year after receiving training. Materials and methods. The translation followed the World Health Organization's recommendations. Reliability was assessed in 25 infants aged between 3 and 15 months with identifiable risks of cerebral palsy (CP). The implementation was also evaluated by analyzing the reliability of professionals without previous experience of the tool by using a pre-survey and a follow-up survey one year after training. The survey covered aspects related to the use of early detection tools of CP and the use of HINE, including attitudes, opinions, and perceptions. Results. An excellent intra- and inter-examiner agreement was obtained for the total score of the HINE intra-class correlation coefficient (ICC = 0.98 in both indices). One year after training, the professionals also showed excellent reliability values (ICC = 0.99), as well as an increase in sensitization and skills in evidence-based practices for the early detection of "high risk" of CP. Conclusions. The Spanish version of HINE is a reliable measure for the neurological evaluation of "high risk" of CP and can be administered after standardized training and without costs to acquire the evaluation. This allows its accessible and widespread implementation in the clinical context.
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Affiliation(s)
- Álvaro Hidalgo-Robles
- Facultad de Educación, Universidad Internacional de La Rioja, 26006 Logroño, Spain; (Á.H.-R.); (I.L.-E.)
| | - Javier Merino-Andrés
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, 45004 Toledo, Spain
- Physiotherapy Research Group of Toledo (GIFTO), Universidad de Castilla-La Mancha, 45004 Toledo, Spain
| | | | | | - Irene León-Estrada
- Facultad de Educación, Universidad Internacional de La Rioja, 26006 Logroño, Spain; (Á.H.-R.); (I.L.-E.)
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Kapil N, Majmudar-Sheth B, Johnson T. Hammersmith Infant Neurological Examination Subscores Are Predictive of Cerebral Palsy. Pediatr Neurol 2024; 151:84-89. [PMID: 38134865 DOI: 10.1016/j.pediatrneurol.2023.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The Hammersmith Infant Neurological Examination (HINE) is a standardized assessment that identifies early signs of cerebral palsy (CP). In practice, the clinician performs this assessment in its entirety, yielding a global score. This study aimed to investigate the individual HINE subscores and "asymmetries" as predictive indicators of CP. METHODS In this retrospective nested case-control study, a pediatric neurologist performed the HINE on a cohort of three- to four-month-old former neonatal intensive care unit infants. The infants' neurodevelopmental outcomes were determined by chart review when they were aged two to three years. We performed univariate and multivariable logistic regression analyses to yield the accuracy of the global HINE score, HINE subscores, and "asymmetries" in classifying infants with and without CP. RESULTS Of the 108 infants on whom HINE was performed, 50 were either discharged due to normal developmental progress or were lost to follow-up. Of the remaining 58 subjects, 17 had CP and 41 did not. Receiver operator characteristic (ROC) curves of univariate models yielded the following area under the curve (AUC) scores: global HINE score (AUC = 0.75), "reflexes and reactions" (AUC = 0.80), "cranial nerve function" (AUC = 0.76), "asymmetries" (AUC = 0.75), and "movements" (AUC = 0.71). The ROC for our multivariable model (AUC = 0.91) surpassed the global HINE score's predictive value for CP. CONCLUSIONS The weighted combination of HINE subscores and "asymmetries" outperforms the global HINE score in predicting CP. These findings suggest the need for revisiting HINE, but further validation with a larger dataset is required.
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Affiliation(s)
- Namarta Kapil
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Bittu Majmudar-Sheth
- Division of Pediatric Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Neurology, Indiana University School of Medicine, Riley Hospital for Children at IU Health, Indianapolis, Indiana
| | - Tara Johnson
- Division of Pediatric Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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Kim F, Maitre N. A Call for Early Detection of Cerebral Palsy. Neoreviews 2024; 25:e1-e11. [PMID: 38161182 DOI: 10.1542/neo.25-1-e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Cerebral palsy (CP) is the most common physical disability across the lifespan, but historically, CP has not been diagnosed before the age of 2 years. Barriers to early diagnosis ranged from lack of available biomarkers, absence of curative treatments, perceived stigma associated with a lifelong diagnosis, and a desire to rule out other diagnoses first. Most importantly, the fundamental question that remained was whether children would benefit from earlier detection and intervention given the paucity of research. However, evidence-based guidelines published in 2017 demonstrated that the General Movements Assessment, the Hammersmith Infant Neurological Examination, and neuroimaging can be combined with other elements such as a clinical history and standardized motor assessments to provide the highest predictive value for diagnosing CP as early as age 3 months in high-risk newborns. Implementation of these guidelines has been successful in decreasing the age at CP diagnosis, particularly in high-risk infant follow-up clinics with expertise in performing these assessments. Early detection of CP allows for clinical and research opportunities investigating earlier interventions during a critical period of neuroplasticity, with the goal of improving developmental trajectories for children and their families. New guidelines and research are now being developed with a focus on early, targeted interventions that continue to be studied, along with global detection initiatives.
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Affiliation(s)
- Faith Kim
- Department of Pediatrics, Columbia University Irving Medical Center/NewYork-Presbyterian Children's Hospital of New York, New York, NY
| | - Nathalie Maitre
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
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Letzkus L, Conaway M, Daugherty R, Hook M, Zanelli S. A randomized-controlled trial of parent-administered interventions to improve short-term motor outcomes in hospitalized very low birthweight infants. J Neonatal Perinatal Med 2024; 17:637-645. [PMID: 39302384 DOI: 10.3233/npm-230206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
BACKGROUND Premature infants are at increased risk for cerebral palsy (CP). Early interventions with a motor focus and administered by parents may improve motor outcomes. AIMS Secondary study evaluating the short-term motor outcomes and risk for CP in very low birthweight (VLBW) infants randomized to multimodal interventions with a motor focus provided by parents versus usual care. STUDY DESIGN Randomized controlled trial (intervention vs. usual care (control group)). SUBJECTS Infants (<32 weeks' gestational age (GA) and/or <1500 grams birthweight) born between March 2019 and October 2020. OUTCOME MEASURES Short-term motor outcomes and risk for CP was evaluated using the Hammersmith Infant Neurological Evaluation (HINE, primary motor outcome), the General Movement Assessment (GMA) and the Test of Infant Motor Performance (TIMP) at 3 months' postmenstrual age (PMA). RESULTS 70 participants were enrolled (GA 28.3±2.7 weeks, birthweight 1139.2±376.6 grams, 64.3% male). The in-person follow-up rate was 73%, lower than expected, in part due to COVID-19 restrictions, resulting in 25 infants (intervention) and 26 infants (control) with outcome data available for analysis. There was not a significant difference in the HINE, GMA or TIMP at 3 months' PMA between groups. CONCLUSION Multimodal interventions with a motor focus and provided by parents need further investigation to determine if they can improve short-term motor outcomes in VLBW infants. These interventions are evidence-based and the evaluation of broader implementation into routine care is also needed.
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Affiliation(s)
- L Letzkus
- Department of Pediatrics, Division of Developmental Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - M Conaway
- Public Health Sciences, University of Virginia, Charlottesville VA, USA
| | - R Daugherty
- Department of Radiology, Division of Pediatric Radiology, University of Virginia, Charlottesville VA, USA
| | - M Hook
- Department of Radiology, Division of Pediatric Radiology, University of Virginia, Charlottesville VA, USA
| | - S Zanelli
- Department of Pediatrics, Division of Neonatology, University of Virginia, Charlottesville, VA, USA
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12
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Deng W, Anastasopoulos S, deRegnier RA, Pouppirt N, Barlow AK, Patrick C, O’Brien MK, Babula S, Sukal-Moulton T, Peyton C, Morgan C, Rogers JA, Lieber RL, Jayaraman A. Protocol for a randomized controlled trial to evaluate a year-long (NICU-to-home) evidence-based, high dose physical therapy intervention in infants at risk of neuromotor delay. PLoS One 2023; 18:e0291408. [PMID: 37725613 PMCID: PMC10508609 DOI: 10.1371/journal.pone.0291408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Developmental disabilities and neuromotor delay adversely affect long-term neuromuscular function and quality of life. Current evidence suggests that early therapeutic intervention reduces the severity of motor delay by harnessing neuroplastic potential during infancy. To date, most early therapeutic intervention trials are of limited duration and do not begin soon after birth and thus do not take full advantage of early neuroplasticity. The Corbett Ryan-Northwestern-Shirley Ryan AbilityLab-Lurie Children's Infant Early Detection, Intervention and Prevention Project (Project Corbett Ryan) is a multi-site longitudinal randomized controlled trial to evaluate the efficacy of an evidence-based physical therapy intervention initiated in the neonatal intensive care unit (NICU) and continuing to 12 months of age (corrected when applicable). The study integrates five key principles: active learning, environmental enrichment, caregiver engagement, a strengths-based approach, and high dosage (ClinicalTrials.gov identifier NCT05568264). METHODS We will recruit 192 infants at risk for neuromotor delay who were admitted to the NICU. Infants will be randomized to either a standard-of-care group or an intervention group; infants in both groups will have access to standard-of-care services. The intervention is initiated in the NICU and continues in the infant's home until 12 months of age. Participants will receive twice-weekly physical therapy sessions and caregiver-guided daily activities, assigned by the therapist, targeting collaboratively identified goals. We will use various standardized clinical assessments (General Movement Assessment; Bayley Scales of Infant and Toddler Development, 4th Edition (Bayley-4); Test of Infant Motor Performance; Pediatric Quality of Life Inventory Family Impact Module; Alberta Infant Motor Scale; Neurological, Sensory, Motor, Developmental Assessment; Hammersmith Infant Neurological Examination) as well as novel technology-based tools (wearable sensors, video-based pose estimation) to evaluate neuromotor status and development throughout the course of the study. The primary outcome is the Bayley-4 motor score at 12 months; we will compare scores in infants receiving the intervention vs. standard-of-care therapy.
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Affiliation(s)
- Weiyang Deng
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | | | - Raye-Ann deRegnier
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Nicole Pouppirt
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ann K. Barlow
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Cheryl Patrick
- Division of Rehabilitative Services, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Megan K. O’Brien
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
| | - Sarah Babula
- Pathways.org, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John A. Rogers
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Departments of Materials Science and Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, United States of America
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Richard L. Lieber
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Jessie Brown Jr., Hines V.A. Medical Center, Hines, Illinois, United States of America
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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13
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Agyeman K, McCarty T, Multani H, Mattingly K, Koziar K, Chu J, Liu C, Kokkoni E, Christopoulos V. Task-based functional neuroimaging in infants: a systematic review. Front Neurosci 2023; 17:1233990. [PMID: 37655006 PMCID: PMC10466897 DOI: 10.3389/fnins.2023.1233990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
Background Infancy is characterized by rapid neurological transformations leading to consolidation of lifelong function capabilities. Studying the infant brain is crucial for understanding how these mechanisms develop during this sensitive period. We review the neuroimaging modalities used with infants in stimulus-induced activity paradigms specifically, for the unique opportunity the latter provide for assessment of brain function. Methods Conducted a systematic review of literature published between 1977-2021, via a comprehensive search of four major databases. Standardized appraisal tools and inclusion/exclusion criteria were set according to the PRISMA guidelines. Results Two-hundred and thirteen papers met the criteria of the review process. The results show clear evidence of overall cumulative growth in the number of infant functional neuroimaging studies, with electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) to be the most utilized and fastest growing modalities with behaving infants. However, there is a high level of exclusion rates associated with technical limitations, leading to limited motor control studies (about 6 % ) in this population. Conclusion Although the use of functional neuroimaging modalities with infants increases, there are impediments to effective adoption of existing technologies with this population. Developing new imaging modalities and experimental designs to monitor brain activity in awake and behaving infants is vital.
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Affiliation(s)
- Kofi Agyeman
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Tristan McCarty
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Harpreet Multani
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Kamryn Mattingly
- Neuroscience Graduate Program, University of California, Riverside, Riverside, CA, United States
| | - Katherine Koziar
- Orbach Science Library, University of California, Riverside, Riverside, CA, United States
| | - Jason Chu
- Division of Neurosurgery, Children’s Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States
| | - Charles Liu
- USC Neurorestoration Center, University of Southern California, Los Angeles, CA, United States
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States
| | - Elena Kokkoni
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Vassilios Christopoulos
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
- Neuroscience Graduate Program, University of California, Riverside, Riverside, CA, United States
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States
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14
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Mendoza-Sengco P, Lee Chicoine C, Vargus-Adams J. Early Cerebral Palsy Detection and Intervention. Pediatr Clin North Am 2023; 70:385-398. [PMID: 37121632 DOI: 10.1016/j.pcl.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Early identification of cerebral palsy (CP) facilitates optimal care, support, and outcomes for children and their families. Ideally, infants with risk factors or developmental deviations should be evaluated early using standardized assessments of neurodevelopment and brain imaging. If a diagnosis of CP or high risk for CP (HRCP) is established, specialized, evidence-informed therapy and family support should be initiated. With task-specific motor skill training and an enriched environment, infants with CP show greater gross motor and cognitive gains. These enhanced outcomes are only achievable with early diagnosis and subsequent intervention.
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Affiliation(s)
- Paola Mendoza-Sengco
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH 45229-3026, USA.
| | - Caitlin Lee Chicoine
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH 45229-3026, USA
| | - Jilda Vargus-Adams
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH 45229-3026, USA
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15
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Feldman SJ, Beslow LA, Felling RJ, Malone LA, Waak M, Fraser S, Bakeer N, Lee JEM, Sherman V, Howard MM, Cavanaugh BA, Westmacott R, Jordan LC. Consensus-Based Evaluation of Outcome Measures in Pediatric Stroke Care: A Toolkit. Pediatr Neurol 2023; 141:118-132. [PMID: 36812698 PMCID: PMC10042484 DOI: 10.1016/j.pediatrneurol.2023.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Following a pediatric stroke, outcome measures selected for monitoring functional recovery and development vary widely. We sought to develop a toolkit of outcome measures that are currently available to clinicians, possess strong psychometric properties, and are feasible for use within clinical settings. A multidisciplinary group of clinicians and scientists from the International Pediatric Stroke Organization comprehensively reviewed the quality of measures in multiple domains described in pediatric stroke populations including global performance, motor and cognitive function, language, quality of life, and behavior and adaptive functioning. The quality of each measure was evaluated using guidelines focused on responsiveness and sensitivity, reliability, validity, feasibility, and predictive utility. A total of 48 outcome measures were included and were rated by experts based on the available evidence within the literature supporting the strengths of their psychometric properties and practical use. Only three measures were found to be validated for use in pediatric stroke: the Pediatric Stroke Outcome Measure, the Pediatric Stroke Recurrence and Recovery Questionnaire, and the Pediatric Stroke Quality of Life Measure. However, multiple additional measures were deemed to have good psychometric properties and acceptable utility for assessing pediatric stroke outcomes. Strengths and weaknesses of commonly used measures including feasibility are highlighted to guide evidence-based and practicable outcome measure selection. Improving the coherence of outcome assessment will facilitate comparison of studies and enhance research and clinical care in children with stroke. Further work is urgently needed to close the gap and validate measures across all clinically significant domains in the pediatric stroke population.
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Affiliation(s)
- Samantha J Feldman
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan J Felling
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura A Malone
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, Maryland
| | - Michaela Waak
- Pediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Queensland, Australia; Pediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Australia
| | - Stuart Fraser
- Division of Vascular Neurology, Department of Pediatrics, University of Texas Health Science Center, Houston, Texas
| | - Nihal Bakeer
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
| | - Jo Ellen M Lee
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Melissa M Howard
- Casa Colina Hospital and Centers for Healthcare, Pomona, California
| | - Beth Anne Cavanaugh
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
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16
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de Oliveira NRG, Teixeira GG, Fernandes KTMS, Avelar MM, Medeiros M, Formiga CKMR. Therapeutic hypothermia as a neuroprotective strategy in newborns with perinatal asphyxia-case report. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1132779. [PMID: 37152243 PMCID: PMC10154559 DOI: 10.3389/fresc.2023.1132779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/01/2023] [Indexed: 05/09/2023]
Abstract
Background Perinatal asphyxia is a public health problem and the third major cause of death among children under 5 years. Objective Two clinical cases of newborns with perinatal asphyxia submitted to therapeutic hypothermia and the follow-up of their motor development after hospital discharge have been reported. Methods This retrospective case report study included two newborns with hypoxic-ischemic encephalopathy due to perinatal asphyxia who received a hypothermia protocol at the neonatal intensive care unit (NICU). The two newborns and their families were followed up at the outpatient clinic and assessed using the Hammersmith Child Neurological Examination, Alberta Child Motor Scale, and Denver Developmental Screening Test-II. Results The newborns were submitted to a 72-hour hypothermia protocol. One newborn remained for 13 days in the NICU, while the other remained for 22 days. According to the multidisciplinary team, both cases presented with typical motor development with no cerebral palsy during the follow-up. Conclusion Both cases showed positive results and a good prognostic for motor development. Therapeutic hypothermia may be a strategy to prevent neurologic sequelae in newborns with perinatal asphyxia, including cerebral palsy.
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Affiliation(s)
| | | | | | - Marla Moreira Avelar
- Department of Medicine, Hospital das Clínicas, Federal University of Goiás-UFG, Goiânia, Brazil
| | - Maja Medeiros
- Department of Medicine, Hospital das Clínicas, Federal University of Goiás-UFG, Goiânia, Brazil
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Pietruszewski L, Moore-Clingenpeel M, Moellering GCJ, Lewandowski D, Batterson N, Maitre NL. Predictive value of the test of infant motor performance and the Hammersmith infant neurological examination for cerebral palsy in infants. Early Hum Dev 2022; 174:105665. [PMID: 36126506 DOI: 10.1016/j.earlhumdev.2022.105665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current recommendations for early detection tools for cerebral palsy (CP) include assessments that vary in feasibility and resource requirements. The predictive value of less resource-intensive tools has not been fully explored. AIMS To determine the predictive value of the Test of Infant Motor Performance (TIMP) at 3-4 months corrected age (CA) for CP, and whether administration of both the TIMP and the Hammersmith Infant Neurological Exam (HINE) improves early CP detection. STUDY DESIGN Five-year retrospective observational study of infants who received the TIMP and the HINE at 3-4 months CA in a high-risk follow-up clinic. TIMP and HINE cut-off scores (alone and in combination) were compared for CP discriminatory ability. SUBJECTS Of patients with HINE scores (n = 1389; 676 [48.7 %] female; median gestational age at birth 31 weeks [interquartile range 29-34 weeks]), 1343 had concurrent TIMP scores available. OUTCOME MEASURES Clinical diagnosis of CP. RESULTS HINE total score <57 had optimal CP predictive value (AUC = 0.815; 77 % sensitivity; 91 % specificity) compared to optimal TIMP cut-off (1 SD below the mean, AUC = 0.71; 52 % sensitivity; 94 % specificity) and all tested TIMP and HINE combinations (all p < 0.001). CONCLUSIONS HINE total score <57 at 3-4 months CA had the best CP predictive value, confirming its value absent first-line detection tools. Concurrent administration of TIMP did not improve predictive value.
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Affiliation(s)
- Lindsay Pietruszewski
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Research Building III, Columbus, OH 43205, USA.
| | - Melissa Moore-Clingenpeel
- Biostatistics Core, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | | | - Dennis Lewandowski
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Research Building III, Columbus, OH 43205, USA
| | - Nancy Batterson
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Research Building III, Columbus, OH 43205, USA
| | - Nathalie L Maitre
- Emory University School of Medicine, 1440 Clifton Rd, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Rd NE, Atlanta, GA 30322, USA
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18
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Romeo DM, Cowan FM, Haataja L, Ricci D, Pede E, Gallini F, Cota F, Brogna C, Romeo MG, Vento G, Mercuri E. Hammersmith Infant Neurological Examination in infants born at term: Predicting outcomes other than cerebral palsy. Dev Med Child Neurol 2022; 64:871-880. [PMID: 35201619 DOI: 10.1111/dmcn.15191] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 01/15/2023]
Abstract
AIM We explored the ability of the Hammersmith Infant Neurological Examination (HINE) to identify cognitive performance delay at 2 years in a large cohort of infants born at term. METHOD We conducted a retrospective study of infants born at term at risk of neurodevelopmental impairments assessed using the HINE between 3 and 12 months post-term age and compared them with a cohort of typically developing infants born at term. All infants performed a neurodevelopmental assessment at 2 years of age using the Mental Development Index (MDI) of the Bayley Scales of Infant Development, Second Edition; the presence of cerebral palsy (CP) was also reported. The infants were classified as being cognitively normal/mildly delayed or significantly delayed (MDI < 70). The predictive validity of HINE scores for significantly delayed cognitive performance, in infants with and without CP, was calculated using specific cut-off scores according to age at assessment. RESULTS A total of 446 at-risk and 235 typically developing infants (345 males, 336 females; mean [SD] gestational age 38.7 weeks [1.4], range 37-43 weeks) were included. Of the at-risk infants, 408 did not have CP at 2 years; 243 had a normal/mild delayed MDI and 165 had an MDI less than 70. Of the at-risk infants, 38 developed CP. HINE scores showed a good sensitivity and specificity, mainly after 3 months, for identifying significantly delayed cognitive performance in infants without CP. In those with CP, the score was associated with their cognitive performance. The comparison group had the highest HINE scores. INTERPRETATION The HINE provides evidence about the risk of delayed cognitive performance at age 2 years in infants born at term with and without CP.
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Affiliation(s)
- Domenico M Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | | | - Leena Haataja
- Pediatric Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniela Ricci
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients - IAPB Italia Onlus, Rome, Italy
| | - Elisa Pede
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Francesca Gallini
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Cota
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mario G Romeo
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Catania, Catania, Italy
| | - Giovanni Vento
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
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19
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de Souza TG, Bagne E, Mizani R, Rotob AA, Gazeta RE, de Sene Amâncio Zara AL, Jundiaí CZV, Passos SD. Accuracy of the Hammersmith infant neurological examination for the early detection of neurological changes in infants exposed to Zika virus: A case-cohort study. Medicine (Baltimore) 2022; 101:e29488. [PMID: 35758386 PMCID: PMC9276139 DOI: 10.1097/md.0000000000029488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/05/2022] [Indexed: 11/26/2022] Open
Abstract
The Hammersmith infant neurological examination (HINE) is a highly predictive tool for the easy and low-cost detection of cerebral palsy. Between 2015 and 2016, the rapid spread of the Zika virus (ZIKV) in Brazil was responsible for an increase in microcephaly cases. This study aimed to verify the accuracy of the HINE for the early detection of neurological problems in Brazilian babies exposed to ZIKV.This was a cross sectional case-control study of children exposed to ZIKV. This study was part of the Jundiaí ZIKV Cohort. Of a total sample of 782 children, 98 were evaluated (26 in the exposed group and 63 in the control group). We included late preterm infants and term infants who were exposed to the ZIKV and were participants in the ZIKV Cohort study. Student's t-test and stepwise multivariate logistic regression were used to compare groups.Of the 26 items evaluated in the five scored categories of the HINE (cranial nerve function, posture, movements, tone, reflexes, and reactions), only the difference in ankle dorsiflexion between the exposed and the control groups was statistically significant. However, some items showed a significant trend in relation to the control group.Our results demonstrated the importance of early neurological assessment of infants exposed to ZIKV, even in those without a microcephaly diagnosis.
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Affiliation(s)
| | - Eduardo Bagne
- Faculdade de Medicina de Jundiaí, Departamento de Pediatria, Jundiaí, SP, Brazil
- Universidade Paulista, UNIP, Jundiaí, SP, Brazil
| | - Renata Mizani
- Faculdade de Medicina de Jundiaí, Departamento de Pediatria, Jundiaí, SP, Brazil
| | | | - Rosa Estela Gazeta
- Faculdade de Medicina de Jundiaí, Departamento de Pediatria, Jundiaí, SP, Brazil
| | - Ana Laura de Sene Amâncio Zara
- Universidade Federal de Goiás, Departamento de Saúde Coletiva, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brazil
| | | | - Saulo Duarte Passos
- Faculdade de Medicina de Jundiaí, Departamento de Pediatria, Jundiaí, SP, Brazil
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Baak LM, Wagenaar N, van der Aa NE, Groenendaal F, Dudink J, Tataranno ML, Mahamuud U, Verhage CH, Eijsermans RMJC, Smit LS, Jellema RK, de Haan TR, ter Horst HJ, de Boode WP, Steggerda SJ, Prins HJ, de Haar CG, de Vries LS, van Bel F, Heijnen CJ, Nijboer CH, Benders MJNL. Feasibility and safety of intranasally administered mesenchymal stromal cells after perinatal arterial ischaemic stroke in the Netherlands (PASSIoN): a first-in-human, open-label intervention study. Lancet Neurol 2022; 21:528-536. [DOI: 10.1016/s1474-4422(22)00117-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/22/2022]
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Luke CR, Benfer K, Mick-Ramsamy L, Ware RS, Reid N, Bos AF, Bosanquet M, Boyd RN. Early detection of Australian Aboriginal and Torres Strait Islander infants at high risk of adverse neurodevelopmental outcomes at 12 months corrected age: LEAP-CP prospective cohort study protocol. BMJ Open 2022; 12:e053646. [PMID: 34996793 PMCID: PMC8744123 DOI: 10.1136/bmjopen-2021-053646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Neurodevelopmental disorders (NDD), including cerebral palsy (CP), autism spectrum disorder (ASD) and foetal alcohol spectrum disorder (FASD), are characterised by impaired development of the early central nervous system, impacting cognitive and/or physical function. Early detection of NDD enables infants to be fast-tracked to early intervention services, optimising outcomes. Aboriginal and Torres Strait Islander infants may experience early life factors increasing their risk of neurodevelopmental vulnerability, which persist into later childhood, further compounding the health inequities experienced by First Nations peoples in Australia. The LEAP-CP prospective cohort study will investigate the efficacy of early screening programmes, implemented in Queensland, Australia to earlier identify Aboriginal and Torres Strait Islander infants who are 'at risk' of adverse neurodevelopmental outcomes (NDO) or NDD. Diagnostic accuracy and feasibility of early detection tools for identifying infants 'at risk' of a later diagnosis of adverse NDO or NDD will be determined. METHODS AND ANALYSIS Aboriginal and/or Torres Strait Islander infants born in Queensland, Australia (birth years 2020-2022) will be invited to participate. Infants aged <9 months corrected age (CA) will undergo screening using the (1) General Movements Assessment (GMA); (2) Hammersmith Infant Neurological Examination (HINE); (3) Rapid Neurodevelopmental Assessment (RNDA) and (4) Ages and Stages Questionnaire-Aboriginal adaptation (ASQ-TRAK). Developmental outcomes at 12 months CA will be determined for: (1) neurological (HINE); (2) motor (Peabody Developmental Motor Scales 2); (3) cognitive and communication (Bayley Scales of Infant Development III); (4) functional capabilities (Paediatric Evaluation of Disability Inventory-Computer Adaptive Test) and (5) behaviour (Infant Toddler Social and Emotional Assessment). Infants will be classified as typically developing or 'at risk' of an adverse NDO and/or specific NDD based on symptomology using developmental and diagnostic outcomes for (1) CP (2) ASD and (3) FASD. The effects of perinatal, social and environmental factors, caregiver mental health and clinical neuroimaging on NDOs will be investigated. ETHICS AND DISSEMINATION Ethics approval has been granted by appropriate Queensland ethics committees; Far North Queensland Health Research Ethics Committee (HREC/2019/QCH/50533 (Sep ver 2)-1370), the Townsville HHS Human Research Ethics Committee (HREC/QTHS/56008), the University of Queensland Medical Research Ethics Committee (2020000185/HREC/2019/QCH/50533) and the Children's Health Queensland HHS Human Research Ethics Committee (HREC/20/QCHQ/63906) with governance and support from local First Nations communities. Findings from this study will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12619000969167.
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Affiliation(s)
- Carly R Luke
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Katherine Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Leeann Mick-Ramsamy
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Arend F Bos
- Department of Neonatology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Margot Bosanquet
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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22
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Maitre NL, Byrne R, Duncan A, Dusing S, Gaebler-Spira D, Rosenbaum P, Winter S. "High-risk for cerebral palsy" designation: A clinical consensus statement. J Pediatr Rehabil Med 2022; 15:165-174. [PMID: 35275579 DOI: 10.3233/prm-220030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nathalie L Maitre
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Stacey Dusing
- University of Southern California, Los Angeles, CA, USA
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23
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Pietruszewski L, Nelin MA, Batterson N, Less J, Moore-Clingenpeel M, Lewandowski D, Levengood K, Maitre NL. Hammersmith Infant Neurological Examination Clinical Use to Recommend Therapist Assessment of Functional Hand Asymmetries. Pediatr Phys Ther 2021; 33:200-206. [PMID: 34417428 PMCID: PMC9413503 DOI: 10.1097/pep.0000000000000822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether asymmetry scores derived from the Hammersmith Infant Neurological Examination (HINE) can provide cutoff scores for recommending in-depth assessment of upper extremity functional deficits by therapists using the Hand Assessment for Infants (HAI). METHODS Observational study in a clinical laboratory with the HINE and the HAI administered concurrently to 101 infants 3 to 12 months corrected age developing typically or atypically. Predictive value of HINE asymmetry scores for atypical HAI was determined. RESULTS Total HINE asymmetry scores of 4 or greater had 100% sensitivity and 88% or greater specificity for identifying infants with an asymmetric HAI score of 3 or greater point difference between hands. CONCLUSIONS For infants receiving a total HINE asymmetry score of 4 or greater, referral to therapists for HAI assessment may be beneficial to precisely evaluate function and determine the need for targeted upper extremity interventions.
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Affiliation(s)
- Lindsay Pietruszewski
- Center for Perinatal Research at the Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Mary Ann Nelin
- Center for Perinatal Research at the Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Nancy Batterson
- Center for Perinatal Research at the Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Julia Less
- Center for Perinatal Research at the Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Melissa Moore-Clingenpeel
- Biostatistics Core at the Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Dennis Lewandowski
- Center for Perinatal Research at the Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Katelyn Levengood
- Center for Perinatal Research at the Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Nathalie L. Maitre
- Center for Perinatal Research at the Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
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24
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Romeo DM, Cowan FM, Haataja L, Ricci D, Pede E, Gallini F, Cota F, Brogna C, Vento G, Romeo MG, Mercuri E. Hammersmith Infant Neurological Examination for infants born preterm: predicting outcomes other than cerebral palsy. Dev Med Child Neurol 2021; 63:939-946. [PMID: 33336801 DOI: 10.1111/dmcn.14768] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/22/2022]
Abstract
AIM We explored the ability of the Hammersmith Infant Neurological Examination (HINE) to identify typical and delayed cognitive performance in a large population of infants born preterm, both with and without cerebral palsy (CP). METHOD We conducted a retrospective study of infants born preterm who had repeated HINEs between 3 and 12 months corrected age. At 2 years, cognition was assessed using the Mental Development Index (MDI; from the Bayley Scales of Infant Development, Second Edition) and the presence and severity of CP was determined. All children were classified as cognitively typical/mildly delayed or significantly delayed (MDI <70) and CP. The predictive validity of HINE scores for significantly delayed cognitive performance, in children with and without CP, was calculated using specific cut-off scores according to age at assessment. RESULTS Of 1229 eligible infants (gestational age 25-36wks, mean [SD] 34.9 [2.3]; 646 males, 583 females), 1108 did not develop CP, 891 had an MDI that was typical/mildly delayed, and 217 had an MDI less than 70. Of the 121 infants who developed CP, the MDI was typical in 28, mildly delayed in 27, and less than 70 in 66. HINE scores showed a good sensitivity and specificity, especially after 3 months, for detecting significantly delayed cognitive performance in infants without CP. In those who developed CP, the score was associated with their cognitive level. INTERPRETATION The HINE provides information about the risk of delayed cognitive performance in infants born preterm with and without CP. What this paper adds The Hammersmith Infant Neurological Examination (HINE) can be used in the first year to identify infants born preterm at risk for delayed cognitive performance. Age-dependent HINE cut-off scores are proposed for detecting increased risk of delayed cognitive performance.
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Affiliation(s)
- Domenico M Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | | | - Leena Haataja
- Division of Pediatric Neurology, Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki, Finland
| | - Daniela Ricci
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients, IAPB Italia Onlus, Rome, Italy
| | - Elisa Pede
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
| | - Francesca Gallini
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Cota
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mario G Romeo
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Catania, Catania, Italy
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy
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25
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Ryll UC, Krumlinde‐Sundholm L, Verhage CH, Sicola E, Sgandurra G, Bastiaenen CHG, Eliasson A. Predictive validity of the Hand Assessment for Infants in infants at risk of unilateral cerebral palsy. Dev Med Child Neurol 2021; 63:436-443. [PMID: 33251586 PMCID: PMC7984072 DOI: 10.1111/dmcn.14739] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the sensitivity, specificity, and predictive value of the Hand Assessment for Infants (HAI) in identifying infants at risk of being diagnosed with unilateral cerebral palsy (CP), and to determine cut-off values for this purpose. METHOD A convenience sample of 203 infants (106 females, 97 males) was assessed by the HAI at 3, 6, 9, and 12 months. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using receiver operating characteristic curve analysis. Cut-off values were derived for different ages. The clinical outcome (unilateral CP yes/no) at 24 months or more served as an external criterion to investigate the predictive validity of HAI. RESULTS Half of the infants developed unilateral CP. The area under the curve ranged from 0.77 (95% CI [confidence interval] 0.63-0.91) to 0.95 (95% CI 0.90-1.00) across HAI scales and age intervals. Likewise, sensitivity ranged from 63% to 93%, specificity from 62% to 91%, and accuracy from 73% to 94%. INTERPRETATION HAI scores demonstrated overall accuracy that ranged from very good to excellent in predicting unilateral CP in infants at risk aged between 3.5 and 12 months. This accuracy increased with age at assessment and the earliest possible prediction was at 3.5 months of age, when appropriate HAI cut-off values for different ages were applied. What this paper adds The Hand Assessment for Infants (HAI) predicts unilateral cerebral palsy (CP) with high accuracy. HAI cut-off values can guide clinical practice for early identification and diagnosis of unilateral CP.
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Affiliation(s)
- Ulrike C Ryll
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | | | - Cornelia H Verhage
- Child Development and Exercise CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Elisa Sicola
- Department of Developmental NeuroscienceIRCCS Fondazione Stella MarisPisaItaly
| | - Giuseppina Sgandurra
- Department of Developmental NeuroscienceIRCCS Fondazione Stella MarisPisaItaly,Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Caroline HG Bastiaenen
- Caphri Research Institute, Program Functioning and RehabilitationDepartment of EpidemiologyMaastricht UniversityMaastrichtthe Netherlands,School of Health ProfessionsDepartment of HealthZurich University of Applied SciencesWinterthurSwitzerland
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26
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Hadders-Algra M. Early Diagnostics and Early Intervention in Neurodevelopmental Disorders-Age-Dependent Challenges and Opportunities. J Clin Med 2021; 10:861. [PMID: 33669727 PMCID: PMC7922888 DOI: 10.3390/jcm10040861] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/20/2022] Open
Abstract
This review discusses early diagnostics and early intervention in developmental disorders in the light of brain development. The best instruments for early detection of cerebral palsy (CP) with or without intellectual disability are neonatal magnetic resonance imaging, general movements assessment at 2-4 months and from 2-4 months onwards, the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment. Early detection of autism spectrum disorders (ASD) is difficult; its first signs emerge at the end of the first year. Prediction with the Modified Checklist for Autism in Toddlers and Infant Toddler Checklist is possible to some extent and improves during the second year, especially in children at familial risk of ASD. Thus, prediction improves substantially when transient brain structures have been replaced by permanent circuitries. At around 3 months the cortical subplate has dissolved in primary motor and sensory cortices; around 12 months the cortical subplate in prefrontal and parieto-temporal cortices and cerebellar external granular layer have disappeared. This review stresses that families are pivotal in early intervention. It summarizes evidence on the effectiveness of early intervention in medically fragile neonates, infants at low to moderate risk, infants with or at high risk of CP and with or at high risk of ASD.
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Affiliation(s)
- Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Department of Paediatrics-Section Developmental Neurology, 9713 GZ Groningen, The Netherlands
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27
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Mazzarella J, McNally M, Richie D, Chaudhari AMW, Buford JA, Pan X, Heathcock JC. 3D Motion Capture May Detect Spatiotemporal Changes in Pre-Reaching Upper Extremity Movements with and without a Real-Time Constraint Condition in Infants with Perinatal Stroke and Cerebral Palsy: A Longitudinal Case Series. SENSORS 2020; 20:s20247312. [PMID: 33352727 PMCID: PMC7766939 DOI: 10.3390/s20247312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/29/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
Perinatal stroke (PS), occurring between 20 weeks of gestation and 28 days of life, is a leading cause of hemiplegic cerebral palsy (HCP). Hallmarks of HCP are motor and sensory impairments on one side of the body—especially the arm and hand contralateral to the stroke (involved side). HCP is diagnosed months or years after the original brain injury. One effective early intervention for this population is constraint-induced movement therapy (CIMT), where the uninvolved arm is constrained by a mitt or cast, and therapeutic activities are performed with the involved arm. In this preliminary investigation, we used 3D motion capture to measure the spatiotemporal characteristics of pre-reaching upper extremity movements and any changes that occurred when constraint was applied in a real-time laboratory simulation. Participants were N = 14 full-term infants: N = six infants with typical development; and N = eight infants with PS (N = three infants with PS were later diagnosed with cerebral palsy (CP)) followed longitudinally from 2 to 6 months of age. We aimed to evaluate the feasibility of using 3D motion capture to identify the differences in the spatiotemporal characteristics of the pre-reaching upper extremity movements between the diagnosis group, involved versus uninvolved side, and with versus and without constraint applied in real time. This would be an excellent application of wearable sensors, allowing some of these measurements to be taken in a clinical or home setting.
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Affiliation(s)
- Julia Mazzarella
- Physical Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA; (J.M.); (D.R.); (A.M.W.C.); (J.A.B.)
| | - Mike McNally
- Tampa Bay Rays, 1 Tropicana Dr., St. Petersburg, FL 33705, USA;
| | - Daniel Richie
- Physical Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA; (J.M.); (D.R.); (A.M.W.C.); (J.A.B.)
| | - Ajit M. W. Chaudhari
- Physical Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA; (J.M.); (D.R.); (A.M.W.C.); (J.A.B.)
- Department of Mechanical and Aerospace Engineering, College of Engineering, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA
| | - John A. Buford
- Physical Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA; (J.M.); (D.R.); (A.M.W.C.); (J.A.B.)
| | - Xueliang Pan
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, 1800 Cannon Drive, Columbus, OH 43210, USA;
| | - Jill C. Heathcock
- Physical Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W 10th Ave., Columbus, OH 43210, USA; (J.M.); (D.R.); (A.M.W.C.); (J.A.B.)
- Correspondence:
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28
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Carey H, Hay K, Nelin MA, Sowers B, Lewandowski DJ, Moore-Clingenpeel M, Maitre NL. Caregiver perception of hand function in infants with cerebral palsy: psychometric properties of the Infant Motor Activity Log. Dev Med Child Neurol 2020; 62:1266-1273. [PMID: 32779197 DOI: 10.1111/dmcn.14644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 02/01/2023]
Abstract
AIM To evaluate the properties of the Infant Motor Activity Log (IMAL), a caregiver-report for frequency and quality of use of more affected upper extremity in infants with neurological and functional impairments. METHOD This was a prospective cohort study of 66 children (34 females, 32 males) aged 6 to 24 months (mean age [SD] 13.7mo [5.3]) with neurological and functional impairments and a confirmed cerebral palsy diagnoses after 2 years, and 51 age-matched typically developing children. The IMAL was administered at baseline and 4 weeks later. Typically developing infants were tested with randomly assigned 'more affected' upper extremity. Psychometric properties were evaluated using Spearman's correlation coefficient, Cronbach's alpha, and Jonckheere-Terpstra tests. RESULTS In the children with impairments, the IMAL showed internal consistency (alpha≥0.88) for the How Well Scale (HWS) and How Often Scale (HOS). Test-retest reliability was 0.64 (HOS) and 0.70 (HWS), demonstrating stability over time. Correlation with Bayley Scales of Infant and Toddler Development, Third Edition more affected arm raw scores were 0.70 (HOS) and 0.72 (HWS) (p<0.001) demonstrating construct validity. Both scale scores decreased with increasing Gross Motor Function Classification System and Mini-Manual Ability Classification System (p<0.001) levels, supporting discriminative validity. Discrimination between typically developing infants and infants with impairments was high (HWS: area under the receiver operating characteristic curve [AUC] 0.96, 95% confidence interval [CI] 0.94-0.99 and HOS AUC=0.95, CI 0.92-0.99). INTERPRETATION The IMAL is a valid and reliable discriminative caregiver measure of upper limb performance and may complement measures of capacity in infants with neurological and functional impairments. WHAT THIS PAPER ADDS The Infant Motor Activity Log (IMAL) is a valid and reliable measure of caregiver perception of upper limb function. The IMAL fills a measurement gap for infant motor performance in children with impairments. The IMAL discriminates among motor function levels.
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Affiliation(s)
- Helen Carey
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Krystal Hay
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mary Ann Nelin
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brianna Sowers
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dennis J Lewandowski
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Melissa Moore-Clingenpeel
- Biostatistics Core, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Nathalie L Maitre
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
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29
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Kinematic and Somatosensory Gains in Infants with Cerebral Palsy After a Multi-Component Upper-Extremity Intervention: A Randomized Controlled Trial. Brain Topogr 2020; 33:751-766. [DOI: 10.1007/s10548-020-00790-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
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30
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Bamat NA, Zhang H, McKenna KJ, Morris H, Stoller JZ, Gibbs K. The Clinical Evaluation of Severe Bronchopulmonary Dysplasia. Neoreviews 2020; 21:e442-e453. [PMID: 32611562 DOI: 10.1542/neo.21-7-e442] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Bronchopulmonary dysplasia is a common disease of prematurity that presents along a wide spectrum of disease severity. Infants with high severity require prolonged hospitalizations and benefit from multidisciplinary care. We describe our approach to the evaluation of infants with severe bronchopulmonary dysplasia. Important considerations include the phenotypic heterogeneity in clinical presentation that necessitates individualized care, the common presence of comorbidities and importance of a comprehensive multisystem evaluation, and the value of applying a chronic care model that prioritizes long-term respiratory and neurodevelopmental goals. Key features of the history, physical examination, and diagnostic studies are discussed with these considerations in mind.
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Affiliation(s)
- Nicolas A Bamat
- Division of Neonatology and Department of Pediatrics, Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Huayan Zhang
- Division of Neonatology and Department of Pediatrics, Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kristin J McKenna
- Division of Neonatology and Department of Pediatrics, Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Heidi Morris
- Division of Neonatology and Department of Pediatrics, Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jason Z Stoller
- Division of Neonatology and Department of Pediatrics, Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kathleen Gibbs
- Division of Neonatology and Department of Pediatrics, Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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31
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Maitre NL, Burton VJ, Duncan AF, Iyer S, Ostrander B, Winter S, Ayala L, Burkhardt S, Gerner G, Getachew R, Jiang K, Lesher L, Perez CM, Moore-Clingenpeel M, Lam R, Lewandowski DJ, Byrne R. Network Implementation of Guideline for Early Detection Decreases Age at Cerebral Palsy Diagnosis. Pediatrics 2020; 145:e20192126. [PMID: 32269135 PMCID: PMC7193973 DOI: 10.1542/peds.2019-2126] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Early diagnosis of cerebral palsy (CP) is critical in obtaining evidence-based interventions when plasticity is greatest. In 2017, international guidelines for early detection of CP were published on the basis of a systematic review of evidence. Our study aim was to reduce the age at CP diagnosis throughout a network of 5 diverse US high-risk infant follow-up programs through consistent implementation of these guidelines. METHODS The study leveraged plan-do-study-act and Lean methodologies. The primary outcome was age at CP diagnosis. Data were acquired during the corresponding 9-month baseline and quarterly throughout study. Balancing measures were clinic no-show rates and parent perception of the diagnosis visit. Clinic teams conducted strengths, weaknesses, opportunities, and threats analyses, process flow evaluations, standardized assessments training, and parent questionnaires. Performance of a 3- to 4-month clinic visit was a critical process step because it included a Hammersmith Infant Neurologic Examination, a General Movements Assessment, and standardized assessments of motor function. RESULTS The age at CP diagnosis decreased from a weighted average of 19.5 (95% confidence interval 16.2 to 22.8) to 9.5 months (95% confidence interval 4.5 to 14.6), with P = .008; 3- to 4-month visits per site increased from the median (interquartile range) 14 (5.2-73.7) to 54 (34.5-152.0), with P < .001; and no-show rates were not different. Parent questionnaires revealed positive provider perception with improvement opportunities for information content and understandability. CONCLUSIONS Large-scale implementation of international guidelines for early detection of CP is feasible in diverse high-risk infant follow-up clinics. The initiative was received positively by families and without adversely affecting clinic operational flow. Additional parent support and education are necessary.
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Affiliation(s)
- Nathalie L Maitre
- Center for Perinatal Research and
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Vera J Burton
- Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Pediatrics and Neurosciences Intensive Care Nursery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Andrea F Duncan
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sai Iyer
- Program of Developmental Behavioral Pediatrics, Department of Pediatrics, Mattel Children's Hospital, and University of California, Los Angeles, Los Angeles, California
| | - Betsy Ostrander
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Sarah Winter
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Lauren Ayala
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | | | - Gwendolyn Gerner
- Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Pediatrics and Neurosciences Intensive Care Nursery, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ruth Getachew
- Division of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland
| | - Kelsey Jiang
- Program of Developmental Behavioral Pediatrics, Department of Pediatrics, Mattel Children's Hospital, and University of California, Los Angeles, Los Angeles, California
| | - Laurie Lesher
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah; and
| | - Carrie M Perez
- Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Rebecca Lam
- Cerebral Palsy Foundation, New York, New York
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Wagenaar N, Verhage CH, de Vries LS, van Gasselt BPL, Koopman C, Leemans A, Groenendaal F, Benders MJNL, van der Aa NE. Early prediction of unilateral cerebral palsy in infants at risk: MRI versus the hand assessment for infants. Pediatr Res 2020; 87:932-939. [PMID: 31722367 DOI: 10.1038/s41390-019-0664-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neonates with unilateral perinatal brain injury (UPBI) are at risk for developing unilateral spastic cerebral palsy (USCP). This study compares several predictors for USCP later in life. METHODS Twenty-one preterm and 24 term born infants with UPBI were included, with an MRI scan including diffusion tensor imaging (DTI) performed at term equivalent age or around 3 months after birth, respectively. T2-weighted images and DTI-based tractography were used to measure the surface area, diameter, and fractional anisotropy (FA) of both corticospinal tracts (CSTs). The hand assessment for infants (HAI) was performed before 5, between 5 and 8 and between 8 and 12 months of (corrected) age. Asymmetry indices were derived from all techniques and related to USCP at ≥2 years of age. RESULTS MRI measures and HAI scores were significantly lower for the affected compared to the unaffected side. Before 5 months of age, FA asymmetry on DTI yielded the highest area under the curve compared to conventional MRI and HAI. CONCLUSIONS Prediction of USCP after UPBI is reliable using asymmetry of the CST on MRI, as well as clinical hand assessment. Before 5 months of age, DTI tractography provides strongest predictive information, while HAI specifically aids to prognosis of USCP at later age points.
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Affiliation(s)
- Nienke Wagenaar
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelia H Verhage
- Child Development and Exercise Centre, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bram P L van Gasselt
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Corine Koopman
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. .,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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te Velde A, Morgan C, Novak I, Tantsis E, Badawi N. Early Diagnosis and Classification of Cerebral Palsy: An Historical Perspective and Barriers to an Early Diagnosis. J Clin Med 2019; 8:E1599. [PMID: 31623303 PMCID: PMC6832653 DOI: 10.3390/jcm8101599] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022] Open
Abstract
Since the 1800s, there have been calls in the literature for the early diagnosis of cerebral palsy (CP). However, diagnosis still often occurs late, from 12 to 24 months in high income countries and as late as 5 years in low resource settings. This is after the optimal timeframe for applying interventions which could harness neuroplastic potential in the developing brain. Multiple barriers exist which affect clinicians' confidence in diagnosing CP early. These range from the lack of definitive biomarkers to a lack of curative treatments for CP. Further barriers to diagnosis are proposed including; (a) difficulty finding a congruent fit with the definition of CP in an infant, where expected activity limitations might not yet be apparent; and (b) differences in the presentation of motor type and topography classifications between infants and children. These barriers may affect a clinicians' confidence using "pattern recognition" in the differential diagnosis process. One of the central tenets of this paper is that diagnosis and classification are different, involving different instruments, and are more accurately conducted separately in infants, whereas they are fundamentally interconnected in older children and inform therapeutic decisions. Furthermore, we need to be careful not to delay early diagnosis because of the low reliability of early classification, but instead uncouple these two processes. Ongoing implementation of best practice for early detection requires creative solutions which might include universal screening for CP. Implementation and accompanying knowledge translation studies are underway to decrease the average age of diagnosis in CP.
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Affiliation(s)
- Anna te Velde
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
| | - Iona Novak
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
| | - Esther Tantsis
- TJ Nelson Department of Neurology & Neurosurgery, The Children's Hospital at Westmead, New South Wales 2145, Australia.
| | - Nadia Badawi
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2050, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, New South Wales 2145, Australia.
- The Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Hawkesbury Road, Westmead NSW 2145, Australia.
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