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Published on: February 2, 2024
Standardizing early cerebral palsy detection in high-risk infants: reducing age at diagnosis through a quality
Sylvan Ryder1, Mallory Kerner-Rossi1, Sandhya Brachio1,2
1Columbia University Medical Center, New York, NY, USA.
Insights
Implementing standardized General Movement Assessment (GMA) and Hammersmith Infant Neurological Examination (HINE) screening in NICU and follow-up clinics significantly lowered the age of cerebral palsy (CP) diagnosis.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Quality improvement in healthcare
Background:
- Cerebral palsy (CP) diagnosis in high-risk infants often occurs late.
- Early detection of CP is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To implement and evaluate the effectiveness of standardized screening for CP in high-risk infants.
- To reduce the age at which CP is diagnosed.
Main Methods:
- Utilized quality improvement methodology to integrate the General Movement Assessment (GMA) and Hammersmith Infant Neurological Examination (HINE).
- Screening was conducted in a level IV Neonatal Intensive Care Unit (NICU) and a high-risk infant follow-up (HRIF) clinic.
- No-show rates were monitored as a balancing measure.
Main Results:
- High screening rates achieved: 89% GMA in NICU, 100% GMA in HRIF, and 87% HINE in HRIF within the first year.
- Median age at CP diagnosis significantly decreased from 18.5 months in 2021 to 7.5 months in 2022 and 8.9 months in 2023 (p < 0.01).
- No-show rates increased from 17% in 2021 to 24% in 2022 (p=0.02).
Conclusions:
- A standardized screening process for CP using GMA and HINE in NICU and HRIF settings is effective.
- The implemented process successfully reduced the age at diagnosis for two consecutive years.
- Continuous quality improvement is key to enhancing screening protocols and early CP detection.
Objective:
To screen high-risk infants for CP in a level IV NICU and high-risk infant follow-up (HRIF) clinic.
Study Design:
By using quality improvement methodology, we implemented the General Movement Assessment (GMA) and Hammersmith Infant Neurological Examination (HINE) to screen for CP and lower age at diagnosis. Main balancing measures included no-show rates.
Results:
Within the first year, 89% of infants had a GMA in the NICU, 100% in HRIF and 87% had a HINE in HRIF. Median age at diagnosis decreased from 18.5 months adjusted [16.7,19.4] in 2021 to 7.5 months [5.9,14.4; p = 0.01] in 2022 and 8.9 months [6.6,12.2; p = 0.01] in 2023. No-show rates increased in 2022 compared to 2021 (24% vs 17%, p = 0.02).
Conclusions:
By implementing and continuously improving a standard process in the NICU and HRIF, we demonstrated a successful increase in screening for CP leading to a lower age at diagnosis sustained for two years.
