CUSCranial ultrasound GMA General movements assessment IVH Intraventricular haemorrhage STARD Standards for Reporting Diagnostic Accuracy AIM This systematic review evaluates the accuracy of predictive assessments and investigations used to assist in the diagnosis of cerebral palsy (CP) in preschool-age children (<5y).METHOD Six databases were searched for studies that included a diagnosis of CP validated after 2 years of age. The validity of the studies meeting the criteria was evaluated using the Standards for Reporting Diagnostic Accuracy criteria. Where possible, results were pooled and a meta-analysis was undertaken.RESULTS Nineteen out of 351 studies met the full inclusion criteria, including studies of general movements assessment (GMA), cranial ultrasound, brain magnetic resonance imaging (MRI), and neurological examination. All studies assessed high-risk populations including preterm (gestational range 23-41wks) and low-birthweight infants (range 500-4350g). Summary estimates of sensitivity and specificity of GMA were 98% (95% confidence interval [CI] 74-100%) and 91% (95% CI 83-93%) respectively; of cranial ultrasound 74% (95% CI 63-83%) and 92% (95% CI 81-96%) respectively; and of neurological examination 88% (95% CI 55-97%) and 87% (95% CI 57-97%) respectively. MRI performed at term corrected age (in preterm infants) appeared to be a strong predictor of CP, with sensitivity ranging in individual studies from 86 to 100% and specificity ranging from 89 to 97% There was inadequate evidence for the use of other predictive tools.SUMMARY This review found that the assessment with the best evidence and strength for predictive accuracy is the GMA. MRI has a good predictive value when performed at termcorrected age. Cranial ultrasound is as specific as MRI and has the advantage of being readily available at the bedside. Studies to date have focused on high-risk infants. The accuracy of these tests in low-risk infants remains unclear and requires further research.Cerebral palsy (CP) occurs in 1 to 3% of live-born infants. 1-3 This increases to 8 to 40% in high-risk populations such as extremely preterm infants. 4 CP is an umbrella term for conditions that are characterized by a nonprogressive, but not unchanging, motor impairment related to brain injury early in development.5-7 The brain injury is characteristically static and results in activity limitation. 7Given the diversity of the clinical picture and implications on management, CP is a diagnosis that is further described by motor type, distribution, functional severity, and comorbidities. 8 Metabolic, syndromic, and genetic conditions that appear similar to CP may present in early life, with a picture of motor impairment. Differentiating these from CP early on has genetic and treatment implications.8 When CP is diagnosed early, surveillance programmes for musculoskeletal and other comorbidities can be instigated and early intervention programmes initiated.9-11 From the child and family's perspective, receiving a diagnosis of CP not only provides 'an answ...

Children living in Hettstedt in eastern Germany have been reported to have a higher prevalence of sensitization to common aeroallergens than another cohort living in the neighboring city of Zerbst; these differences correlated with the presence of industrial air pollution. Samples of fine particulate matter (< 2.5 micro m aerodynamic diameter; PM(2.5)) collected in Hettstedt in 1999 had several-fold higher levels of zinc, magnesium, lead, copper, and cadmium than samples from Zerbst. To determine if the results from epidemiologic studies could be repeated in an animal model, we administered PM(2.5) from Hettstedt and Zerbst to ovalbumin-allergic mice. In Balb/c mice, PM(2.5) from Hettstedt, but not PM(2.5) from Zerbst or control filter extract, caused a significant increase in immediate responses to ovalbumin challenge when aspirated 2 hr before challenge, but not when aspirated immediately before sensitization 2 weeks earlier. Antigen-specific IgE was increased by Hettstedt PM(2.5) whether administered before sensitization or challenge. Airway responsiveness to methacholine aerosol and lung inflammatory cell numbers were significantly increased only in allergic mice exposed to Hettstedt PM(2.5) before challenge. Both Hettstedt and Zerbst PM(2.5) significantly increased lung injury parameters and proinflammatory cytokines. These results are consistent with epidemiologic findings and show that metal composition of ambient PM(2.5) influences the severity of allergic respiratory disease.

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