Assessing the Utility of Neonatal Screening Assessments in Early Diagnosis of Cerebral Palsy in Preterm Infants
Background: Early diagnosis of cerebral palsy (CP) in high-risk infants is possible at 3–4 months’ corrected age (CA) using standardised assessments. Aim: To assess the utility of neonatal screening assessments—writhing general movements (GMs) and the Hammersmith Neonatal Neurological Examination (H...
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| Format: | Article |
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MDPI AG
2022-06-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/12/7/847 |
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| author | Rebecca Connors Vathana Sackett Catherine Machipisa Kenneth Tan Pramod Pharande Lindsay Zhou Atul Malhotra |
| author_facet | Rebecca Connors Vathana Sackett Catherine Machipisa Kenneth Tan Pramod Pharande Lindsay Zhou Atul Malhotra |
| author_sort | Rebecca Connors |
| collection | DOAJ |
| description | Background: Early diagnosis of cerebral palsy (CP) in high-risk infants is possible at 3–4 months’ corrected age (CA) using standardised assessments. Aim: To assess the utility of neonatal screening assessments—writhing general movements (GMs) and the Hammersmith Neonatal Neurological Examination (HNNE)—to predict CP/high-risk status at 3–4 months’ CA in extremely preterm infants. Methods: Retrospective cohort study of high-risk preterm infants (born < 29 weeks’ gestation and/or birth weight < 1000 g) attending an Early Neurodevelopment Clinic. Data from neonatal assessments were compared with CP/high-risk diagnosis at 3–4 months’ CA, fidgety GMs, and Hammersmith Infant Neurological Examinations (HINE) using logistic regression, linear regression, and Spearman rank correlation. Results: Two hundred and two preterm infants (median gestation age at birth 27.3 (IQR 25.4–28.3) weeks, mean birth weight 870.3 (SD 248.4) grams) were included. A total of 26 (12.8%) infants received early CP/high-risk diagnoses at 3–4 months’ CA. A lower gestational age (GA) (OR = 0.78; <i>p</i> = 0.029, 95% CI [0.26, 0.97]) and abnormal writhing GMs (OR 1.56; <i>p</i> = 0.019, 95% CI [1.07, 2.27]) were predictive of CP/high-risk diagnosis. Although after adjustment for sex, GA, birth weight, and growth restriction, GA (aOR = 0.67; <i>p</i> = 0.068, 95% CI [0.44, 1.03]) and writhing GMs (aOR = 1.44; <i>p</i> = 0.087, 95% CI [0.95, 2.20]) were not significant, a strong trend still persisted. The HNNE scores significantly correlated with both the HINE evaluation (r<sub>s</sub> = 0.43, <i>p</i> < 0.001, 95% CI [0.31, 0.56]) and fidgety GMs (r<sub>s</sub> = −0.10, <i>p</i> = 0.012, 95% CI [−0.32, −0.04]). Linear regression confirmed the HNNE was highly predictive of the HINE (correlation coefficient 0.82; <i>p</i> < 0.001, 95% CI [0.48, 1.15]). Writhing GMs did not significantly correlate with either fidgety GMs (<i>p</i> = 0.723, 95% CI [−0.12, 0.17]) or the HINE (<i>p</i> = 0.173, 95% CI [−0.24, 0.04]). Conclusions: Abnormal writhing GMs in the neonatal period were non-significantly associated with early CP/high-risk diagnoses in extremely preterm infants in a multivariate analysis. Additionally, the HNNE significantly correlated with both fidgety GMs and the HINE. |
| first_indexed | 2024-03-09T12:09:23Z |
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| id | doaj.art-279a915b5fdc4a49b769ce2ff10a8c38 |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-09T12:09:23Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
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| series | Brain Sciences |
| spelling | doaj.art-279a915b5fdc4a49b769ce2ff10a8c382023-11-30T22:53:43ZengMDPI AGBrain Sciences2076-34252022-06-0112784710.3390/brainsci12070847Assessing the Utility of Neonatal Screening Assessments in Early Diagnosis of Cerebral Palsy in Preterm InfantsRebecca Connors0Vathana Sackett1Catherine Machipisa2Kenneth Tan3Pramod Pharande4Lindsay Zhou5Atul Malhotra6Department of Paediatrics, Monash University, Melbourne, VIC 3800, AustraliaAllied Health Department, Monash Children’s Hospital, Melbourne, VIC 3168, AustraliaAllied Health Department, Monash Children’s Hospital, Melbourne, VIC 3168, AustraliaDepartment of Paediatrics, Monash University, Melbourne, VIC 3800, AustraliaMonash Newborn, Monash Children’s Hospital, Melbourne, VIC 3168, AustraliaDepartment of Paediatrics, Monash University, Melbourne, VIC 3800, AustraliaDepartment of Paediatrics, Monash University, Melbourne, VIC 3800, AustraliaBackground: Early diagnosis of cerebral palsy (CP) in high-risk infants is possible at 3–4 months’ corrected age (CA) using standardised assessments. Aim: To assess the utility of neonatal screening assessments—writhing general movements (GMs) and the Hammersmith Neonatal Neurological Examination (HNNE)—to predict CP/high-risk status at 3–4 months’ CA in extremely preterm infants. Methods: Retrospective cohort study of high-risk preterm infants (born < 29 weeks’ gestation and/or birth weight < 1000 g) attending an Early Neurodevelopment Clinic. Data from neonatal assessments were compared with CP/high-risk diagnosis at 3–4 months’ CA, fidgety GMs, and Hammersmith Infant Neurological Examinations (HINE) using logistic regression, linear regression, and Spearman rank correlation. Results: Two hundred and two preterm infants (median gestation age at birth 27.3 (IQR 25.4–28.3) weeks, mean birth weight 870.3 (SD 248.4) grams) were included. A total of 26 (12.8%) infants received early CP/high-risk diagnoses at 3–4 months’ CA. A lower gestational age (GA) (OR = 0.78; <i>p</i> = 0.029, 95% CI [0.26, 0.97]) and abnormal writhing GMs (OR 1.56; <i>p</i> = 0.019, 95% CI [1.07, 2.27]) were predictive of CP/high-risk diagnosis. Although after adjustment for sex, GA, birth weight, and growth restriction, GA (aOR = 0.67; <i>p</i> = 0.068, 95% CI [0.44, 1.03]) and writhing GMs (aOR = 1.44; <i>p</i> = 0.087, 95% CI [0.95, 2.20]) were not significant, a strong trend still persisted. The HNNE scores significantly correlated with both the HINE evaluation (r<sub>s</sub> = 0.43, <i>p</i> < 0.001, 95% CI [0.31, 0.56]) and fidgety GMs (r<sub>s</sub> = −0.10, <i>p</i> = 0.012, 95% CI [−0.32, −0.04]). Linear regression confirmed the HNNE was highly predictive of the HINE (correlation coefficient 0.82; <i>p</i> < 0.001, 95% CI [0.48, 1.15]). Writhing GMs did not significantly correlate with either fidgety GMs (<i>p</i> = 0.723, 95% CI [−0.12, 0.17]) or the HINE (<i>p</i> = 0.173, 95% CI [−0.24, 0.04]). Conclusions: Abnormal writhing GMs in the neonatal period were non-significantly associated with early CP/high-risk diagnoses in extremely preterm infants in a multivariate analysis. Additionally, the HNNE significantly correlated with both fidgety GMs and the HINE.https://www.mdpi.com/2076-3425/12/7/847CPGMAHINEHINEpredictiontherapies |
| spellingShingle | Rebecca Connors Vathana Sackett Catherine Machipisa Kenneth Tan Pramod Pharande Lindsay Zhou Atul Malhotra Assessing the Utility of Neonatal Screening Assessments in Early Diagnosis of Cerebral Palsy in Preterm Infants Brain Sciences CP GMA HINE HINE prediction therapies |
| title | Assessing the Utility of Neonatal Screening Assessments in Early Diagnosis of Cerebral Palsy in Preterm Infants |
| title_full | Assessing the Utility of Neonatal Screening Assessments in Early Diagnosis of Cerebral Palsy in Preterm Infants |
| title_fullStr | Assessing the Utility of Neonatal Screening Assessments in Early Diagnosis of Cerebral Palsy in Preterm Infants |
| title_full_unstemmed | Assessing the Utility of Neonatal Screening Assessments in Early Diagnosis of Cerebral Palsy in Preterm Infants |
| title_short | Assessing the Utility of Neonatal Screening Assessments in Early Diagnosis of Cerebral Palsy in Preterm Infants |
| title_sort | assessing the utility of neonatal screening assessments in early diagnosis of cerebral palsy in preterm infants |
| topic | CP GMA HINE HINE prediction therapies |
| url | https://www.mdpi.com/2076-3425/12/7/847 |
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