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Screening for cerebral palsy in preterm infants: delay criteria for motor milestone attainment
1Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md.
Insights
A 50% delay in motor milestones effectively screens high-risk preterm infants for cerebral palsy. This practical method identifies at-risk infants efficiently, aiding early intervention for cerebral palsy.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Public health screening
Background:
- High-risk preterm infants (gestational age < 32 weeks) require effective screening for developmental disorders.
- Cerebral palsy (CP) is a significant concern in this population, necessitating reliable early identification methods.
- Current screening tools may have limitations in sensitivity, specificity, or practicality.
Purpose of the Study:
- To evaluate the efficacy of different delay criteria (12.5% to 50%) for motor milestone attainment in screening preterm infants for cerebral palsy.
- To determine the optimal delay threshold balancing sensitivity, specificity, and positive predictive value for early CP detection.
- To assess the practicality and cost-effectiveness of using motor milestone history for screening.
Main Methods:
- A cohort of 173 high-risk preterm infants (GA < 32 weeks) was followed from birth to 18-24 months.
- Motor milestone attainment data was collected during routine child care visits.
- Various delay criteria (12.5%, 25%, 37.5%, 5%, 50%) were analyzed for screening performance, considering prematurity.
- Sensitivity, specificity, and positive predictive values were calculated for each criterion.
Main Results:
- Lower delay thresholds (12.5%, 25%) showed higher sensitivity but lower specificity and positive predictive values.
- A 50% delay criterion demonstrated excellent specificity (81%-95%) and positive predictive values (48%-85%).
- Despite slightly lower sensitivity, the 50% delay criterion is favored due to its high specificity and positive predictive value, crucial for resource allocation.
Conclusions:
- Using a 50% delay in motor milestone attainment is a practical, inexpensive screening method for identifying preterm infants at high risk of cerebral palsy.
- Integrating motor milestone history collection into routine child care visits, adjusted for prematurity, offers an efficient screening approach.
- This method supports early identification and intervention for cerebral palsy, optimizing the use of limited healthcare resources.
Abstract:
We evaluated the efficacy of various delay criteria (12.5%, 25%, 37.5%, 5%, 50% delay) for motor milestone attainment to screen a sample of 173 high-risk preterm infants with gestational age < 32 weeks who had been sequentially followed for 18 to 24 months. Sensitivities were best with 12.5% and 25% delays, but specificities and positive predictive values were relatively lower. Since societal resources for evaluation and treatment of cerebral palsy are limited, the excellent specificities (81% to 95%) and positive predictive values (48% to 85%) with 50% delay are more important than the somewhat lower sensitivities, especially since milestones involve a multistep screening process. Screening preterm infants by obtaining a history of motor milestone attainment with each child care visit, correcting for degree of prematurity, and using a 50% delay criteria is a practical, inexpensive method of identifying infants at highest risk of cerebral palsy.