Early Detection of Cerebral Palsy Using Standardized Screening Assessments in Neonatal Hypoxic Ischemic Encephalopathy: A Pilot Case Series

Abstract

Prechtl's General Movement Assessment (GMA) and the Hammersmith Infant Neurological Exam (HINE) are recommended for early detection of cerebral palsy (CP) in high-risk infants. These tools are well validated in premature infants but less well studied in the high-risk term population. We sought to determine the added prognostic value of incorporating GMA and HINE assessment in term- and near-term infants with hypoxic ischemic encephalopathy (HIE) who underwent therapeutic hypothermia (TH). In this retrospective and prospective pilot case series of 20 neonates with HIE that were treated with TH, we analyzed the associations between HIE severity, early clinical course, electroencephalography (EEG) background, and magnetic resonance imaging (MRI) injury pattern, with performance on the GMA and HINE. Absence of fidgety movements was significantly associated with severity of EEG background and was most concordant with gray matter injury score on MRI. There were no significant associations between 3-month HINE scores and any clinical measure. Three-month HINE scores were overall lower than published norms for age and tended to normalize over time in patients that had normal fidgety movements. Although the generalizability of these findings is limited because of the small sample size and lack of long-term outcomes, they support incorporation of the GMA as an early outcome in the follow-up of this population for accurate early identification of CP, which is complemented by longitudinal HINE scores for further delineation of severity and topography.