A systematic review of tests to predict cerebral palsy in young children

Abstract

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...

Validation of an MRI Brain Injury and Growth Scoring System in Very Preterm Infants Scanned at 29- to 35-Week Postmenstrual Age

“…41,42 A combination of TEA MR imaging findings and 3-month CA general movement assessment demonstrates improved predictive validity over TEA MR imaging alone, [43][44][45] so evaluation of the relationships between this early MR imaging scoring system and concurrent clinical measures and the combination of early MR imaging and clinical measures to predict later outcomes is warranted.…”

White Matter Injury and General Movements in High-Risk Preterm Infants

“…Most important, absence of these FM at 10 -15 weeks' postterm accurately predicts the development of cerebral palsy. 3 Where in the brain FM arise and how they are generated remain unclear. However, the absence of FM in infants with periventricular lesions of the corona radiata or internal capsule 4 suggests that projections between the cortex and spinal cord may contribute to these movements.…”

The comparison of general movements assessment and neurological examination during early infancy

“…According to a review 23 there is good evidence that GMs assessment can accurately predict the development of CP. In our study, infants who had persistant abnormal GMs showed CP sypmtoms and those who had normal GMs demonstrated normal neurologic development at a corrected age of 12 months, which supports findings in the literature.…”