New Guidelines Can Help Better Diagnosis CP in Full-term Infants, Allowing Earlier Treatment, Paper Says

A new review provides three steps pediatricians can take to better diagnose cerebral palsy in full-term infants who don’t have “red flag” signs of the disease. These strategies may help children with CP to gain earlier access to interventions — allowing treatment to begin during the critical periods of brain development, researchers say.

Titled “Diagnosing cerebral palsy in full-term infants,” the paper was published in the Journal of Paediatrics and Child Health.

Cerebral palsy (CP) is caused by damage to the developing brain, usually before birth. While some infants have a clinical history predictive of CP, such as brain damage, others have no readily identifiable risk factors. Thus, diagnosing CP — and ruling out other movement disorders that may have similar symptoms — can be challenging. This is particularly the case for infants with CP who are born at term — slightly more than half of people with the disease —who present no immediate red flags.

Because of the difficulty in diagnosing full-term infants, there is often a diagnostic delay, the researchers said. They note that pediatricians are often tempted to “wait and see.” rather than risk giving an incorrect diagnosis.

That, however, delays patients receiving interventions and treatments that can do good — especially when implemented early in life, when the brain has more plasticity.

Thus, this paper outlines three overarching steps pediatricians can take to improve cerebral palsy diagnosis for infants born at full term.

The first step is the taking of a thorough clinical history. This can allow the pediatrician to note risk factors for CP that might otherwise go unnoticed, the researchers said.

The paper provides an exhaustive list of factors in pregnancy, as well as during and after birth, that can increase the risk of CP. Stroke and encephalopathy (brain damage), in particular, were highlighted as CP risk factors.

The second step is to plan out assessments, including imaging, specifically magnetic resonance imaging (MRI) scans, genetic tests, and standardized motor examinations. Although none of these tests is perfect — for example, as many as 16% of people with CP have normal MRI scans — using them holistically can often give pediatricians a clearer picture.

The paper’s authors particularly highlight two motor skill tests that are effective at diagnosing cerebral palsy: Prechtl’s qualitative assessment of general movements (GMA) and the Hammersmith Infant Neurological Examination. In contrast, assessments that focus on motor milestones usually aren’t good at identifying CP unless they are used over time, the researchers said. They recommend tailoring the particular test done as appropriate for the child’s age.

Finally, the third step is identifying comorbidities — the occurrence of other chronic diseases or conditions — in the child and coming up with strategies to handle them.

“In the first year of life, regularly checking in with parents about the child’s pain and sleep is an essential part of best practice care,” the researchers said.

The papers’ authors stressed that waiting for a definitive diagnosis is often not the best strategy, either for the health of the child or the mental state of the parents. Instead, they recommend using the term “high risk of cerebral palsy” when a diagnosis isn’t entirely certain. That way, they say, patients may still begin to receive helpful interventions and treatments.