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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Early recognition of infants at high risk for cerebral palsy: examination at age four months
Insights
Early infant examination can predict cerebral palsy (CP) risk. Four-month-old infants with abnormal neurological signs, especially increased muscle tone, face a higher CP risk by age seven.
Area of Science:
- Pediatrics
- Neurology
- Developmental Pediatrics
Background:
- Cerebral palsy (CP) is a significant developmental disability.
- Early identification of infants at risk for CP is crucial for timely intervention.
- Predictive markers for CP in early infancy require further investigation.
Purpose of the Study:
- To assess the predictive value of four-month infant examinations for the development of cerebral palsy by age seven.
- To identify specific neurological signs at four months that are most indicative of later CP.
Main Methods:
- A cohort of over 32,000 infants was prospectively studied.
- Infants underwent neurological assessment at four months postpartum.
- Children were re-evaluated at seven years of age to diagnose cerebral palsy.
Main Results:
- Infants with normal neurological status at four months had a 0.1% CP rate by age seven.
- Infants with suspect neurological status had a 1% CP rate.
- Infants with definite neurological abnormalities had a 14% CP rate.
- Increased muscle tone was the most reliable individual predictor.
- Meeting motor milestones significantly reduced CP risk, irrespective of physical findings.
Conclusions:
- Four-month infant examinations effectively stratify risk for cerebral palsy.
- Early neurological assessment can identify infants at high risk for chronic motor handicaps.
- Timely recognition of risk allows for targeted early intervention strategies.
Abstract:
More than 32,000 children in a prenatally-defined cohort were examined four months after birth, and were re-examined at the age of seven years to determine the presence of cerebral palsy. Observations from the examination at four months were investigated as predictors of cerebral palsy, and the most reliable individual sign was increased muscle tone in neck, arms, legs or trunk. On completion of the physical examination at four months, the neurological status of each infant was assessed. Of the children considered to be normal, one in 1000 had cerebral palsy by the age of seven years, compared with one in 100 of those thought to be suspect. Of the children who had been definitely neurologically abnormal at four months, one in seven had disabling cerebral palsy by early school-age. The predictive power of abnormal physical findings increased with the number of abnormal findings with failure to meet motor milestones. Four-month-old infants who passed all milestone measures had a very low rate of later cerebral palsy, even if they had had abnormal physical findings. Examination of four-month-old infants permits the clinician to recognize children at widely different levels of risk of chronic motor handicap.
