Early Detection of Cerebral Palsy in Ireland: A National NICU Implementation Initiative

To implement standardized early cerebral palsy (CP) detection pathways nationally across all tertiary neonatal intensive care unit (NICU) follow-up programs in Ireland, with the aim to reduce the median age of CP diagnosis to ≤12 months corrected age.

Active implementation framework methodology was used to adapt the US CP Early Detection and Intervention Network toolkit for the Irish context (May 2023-Dcember 2025). Pathways, criteria, and assessment schedules were standardized. Baseline data from a retrospective cohort of high-risk infants cared for at each site over a 1-year period 30 months prior to implementation were collected. The primary outcome was age at CP diagnosis. Process measures included the proportion having pre-specified standardized assessments. Balancing measures were selected to monitor for potential unintended consequences of the adjusted assessment schedule and an earlier diagnosis and included clinic attendance at 3-4- month corrected age and parent feedback. Baseline (pre-implementation) and prospective (post-implementation) cohorts were compared using control and run charts and standard statistical tests.

1161 high-risk infants were included (374 baseline, 787 post-implementation). Median age at CP diagnosis decreased from 24 (IQR:16-30) to 7 months (IQR:5-11) corrected age (P<0.001). Process measures improved, with assessments performed in the neonatal and 3-4-month periods at 88-90.6% by study end (all P<0.001 vs. baseline). Parental feedback was generally positive, with opportunities identified for improving information delivery.

National implementation of early CP surveillance was feasible across tertiary NICU programs in Ireland and reduced median age of diagnosis to 7 months. Future work must establish feasibility beyond tertiary settings and work to incorporate pathways into national priorities to ensure sustainability.