RESUMO
OBJECTIVE: To describe the implementation of the international guidelines for the early diagnosis of cerebral palsy (CP) and engagement in the screening process in an Australian cohort of infants with neonatal risk factors for CP. STUDY DESIGN: Prospective cohort study of infants with neonatal risk factors recruited at <6 months corrected age from 11 sites in the states of Victoria, New South Wales, and Queensland, Australia. First, we implemented a multimodal knowledge translation strategy including barrier identification, technology integration, and special interest groups. Screening was implemented as follows: infants with clinical indications for neuroimaging underwent magnetic resonance imaging and/or cranial ultrasound. The Prechtl General Movements Assessment (GMA) was recorded clinically or using an app (Baby Moves). Infants with absent or abnormal fidgety movements on GMA videos were offered further assessment using the Hammersmith Infant Neurological Examination (HINE). Infants with atypical findings on 2/3 assessments met criteria for high risk of CP. RESULTS: Of the 597 infants (56% male) recruited, 95% (n = 565) received neuroimaging, 90% (n = 537) had scorable GMA videos (2% unscorable/8% no video), and 25% (n = 149) HINE. Overall, 19% of the cohort (n = 114/597) met criteria for high risk of CP, 57% (340/597) had at least 2 normal assessments (of neuroimaging, GMA or HINE), and 24% (n = 143/597) had insufficient assessments. CONCLUSIONS: Early CP screening was implemented across participating sites using a multimodal knowledge translation strategy. Although the COVID-19 pandemic affected recruitment rates, there was high engagement in the screening process. Reasons for engagement in early screening from parents and clinicians warrant further contextualization and investigation.
Assuntos
Paralisia Cerebral , Pesquisa Translacional Biomédica , Humanos , Paralisia Cerebral/diagnóstico , Masculino , Feminino , Estudos Prospectivos , Recém-Nascido , Lactente , Austrália , Diagnóstico Precoce , Fatores de Risco , Imageamento por Ressonância Magnética , Triagem Neonatal/métodos , Neuroimagem , Estudos de Coortes , Exame Neurológico/métodos , COVID-19/epidemiologia , COVID-19/diagnósticoRESUMO
OBJECTIVE: To evaluate the prevalence and associations between structural magnetic resonance imaging (sMRI) injury/abnormality at term-equivalent age and absent fidgety General Movements Assessment (GMA) and abnormal Hammersmith Infant Neurological Examination (HINE) scores among infants born very preterm at 3-4 months of corrected age. STUDY DESIGN: This prospective cohort study enrolled 392 infants born ≤2 weeks of gestation from 5 neonatal intensive care units in the greater Cincinnati area between September 2016 and October 2019. Infants completed sMRI at term-equivalent age and GMA and HINE at 3-4 months of corrected age. All assessors were blinded. RESULTS: Of 392 infants, 375 (96%) had complete data. Of these, 44 (12%) exhibited moderate or severe brain abnormalities, 17 (4.5%) had abnormal GMA, and 77 (20.3%) had abnormal HINE. Global and regional abnormality scores on sMRI were significantly correlated with GMA (R2 range 0.05-0.17) and HINE at 3-4 months of corrected age (R2 range 0.01-0.17). These associations remained significant in multivariable analyses after adjusting for gestational age and sex. There was a significant but low correlation (R2 0.14) between GMA and HINE. CONCLUSIONS: We observed a low prevalence of moderate or severe brain abnormalities in survivors born very preterm in this geographically defined cohort. The much greater prevalence of abnormal motor examination on the HINE compared with GMA and their low correlation suggests that these tests evaluate different constructs and, thus, should be used in combination with sMRI rather than interchangeably.
Assuntos
Encéfalo/anormalidades , Encéfalo/diagnóstico por imagem , Lactente Extremamente Prematuro , Imageamento por Ressonância Magnética , Exame Neurológico , Paralisia Cerebral/diagnóstico , Estudos de Coortes , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , MasculinoRESUMO
AIM: The aim of the study was to assess general spontaneous motor development in the neonatal phase in groups of neonatal high-risk preterm infants who were differentiated by post-conceptional (PCo) age until term age. METHOD: The sample included 54 preterm infants (<32â¯weeks of gestational age) with low birthweight and neurological injuries of both sexes. The General Movements Assessment (GMA) was used to evaluate motor development from 30 to 40â¯weeks of PCo age, using the General Movements Optimality Score (GMOS). Between-group and within-group comparisons were performed. RESULTS: Significant differences in GMOS scores and the upper extremities score, specifically in the neck and trunk, were found between 30 and 33â¯weeks, 34 and 36â¯weeks, and 38 and 40â¯weeks of PCo age. Preterm infants had gradually higher GMOSs from 30â¯weeks of PCo age to term age (38-40â¯weeks of PCo age). No significant differences in general movements were found between 30 and 33 and 34 and 36â¯weeks of PCo age. CONCLUSION: The preterm infants presented poor spontaneous motor movements, assessed by the GMOS, but gradual improvement was observed from 30â¯weeks of PCo age until term age.