Factors Associated with High Risk of Cerebral Palsy: Development of a Multicriteria Index
Lara de Almeida Rodrigues1, Rafael Coelho Magalhães2, Bernat Vinolas Prat3
1Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Insights
A new multicriteria index accurately identifies infants at high risk for cerebral palsy (CP) using key clinical factors. This tool aids in early detection and intervention for high-risk newborns following neonatal intensive care unit (NICU) stays.
Area of Science:
- Neonatal neurology
- Pediatric developmental disorders
- Clinical risk assessment
Background:
- Cerebral palsy (CP) is a significant concern in high-risk infants.
- Early identification of CP risk is crucial for timely intervention.
- Existing methods may not fully capture the multifactorial nature of CP risk in neonates.
Purpose of the Study:
- To develop and validate a multicriteria index for identifying infants at high risk of cerebral palsy (CP).
- To incorporate key clinical factors associated with CP into a predictive index.
- To improve the precision of risk assessment for infants with a history of neonatal intensive care unit (NICU) admission.
Main Methods:
- An exploratory cross-sectional study included 92 infants discharged from NICUs in Brazil.
- Infants were assessed using General Movements (GMs) and Hammersmith Infant Neurological Examination (HINE).
- A multicriteria index integrated factors including TORCHSZ infections, prematurity, birth asphyxia, Apgar scores, seizures, ventilation duration, and specific medications.
Main Results:
- The developed index demonstrated a moderate positive association with high CP risk (R²=0.20, p<0.0001).
- Abnormal GMs and HINE results were key indicators of high risk.
- Significant differences in risk were observed between low- and high-risk groups (p<0.0001) and medium- and high-risk groups (p=0.005).
Conclusions:
- The multicriteria high-risk CP index effectively identifies infants with CP risk post-NICU admission.
- Combining clinical factors in the index enhances the identification of high-risk infants.
- This tool can assist healthcare professionals in making more accurate referrals for early intervention programs.
Aims:
To develop a multicriteria index with the main factors associated with high risk of cerebral palsy (CP).
Methods:
Exploratory cross-sectional study. Ninety-two infants, mean age 94.8 (±13.5) days, discharged from neonatal intensive care units (NICU) in Brazil, were included, and assessed using the General Movements (GMs) and Hammersmith Infant Neurological Examination (HINE). The multicriteria index incorporated factors such as infections from the toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis, and zika virus (TORCHSZ), prematurity, birth asphyxia, Apgar score, seizures, duration of mechanical ventilation, corticosteroid and magnesium sulfate medications, therapeutic hypothermia, and caffeine. Validation included the Pearson correlation, simple linear regression analysis, and one-way analysis of variance (ANOVA), with Tukey's post hoc test.
Results:
The multicriteria index showed a positive and moderate association with high risk of CP (R2=0.20, p < 0.0001), indicated by abnormal GMs and HINE results. Significant differences between the low- and high-risk groups (p < 0.0001) and between the medium- and high-risk groups (p = 0.005) of CP were found.
Conclusions:
The multicriteria high risk CP index, developed by combining clinical factors, enabled the identification of high-risk infants with CP and a history of NICU admission. These findings can support healthcare professionals in making more precise referrals for early intervention.
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