A recent review by a multidisciplinary, international group of CP experts focused on the following tools with
the best predictive validity for detection of CP before 5 months of age:

neonatal magnetic resonance imaging (MRI) (86%–89% sensitivity), the Prechtl Qualitative Assessment of General Movements (GMA) (98% sensitivity), and the Hammersmith Infant Neurologic Examination (HINE) (90% sensitivity) [6].

HINE scores at 3, 6, 9 or 12 months:HINE proforma_07_07_17

• 50-73 indicates likely unilateral cerebral palsy (i. . 95-99% will walk)

• <50 indicates likely bilateral cerebral palsy

HINE scores at 3-6 months:

• 40-60 indicates likely GMFCS I-II

• <40 indicates likely GMFCS III-V
These investigators recommend that infants with newborn-detectable risk factors for CP undergo a standardized neurologic examination, motor assessment,and neuroimaging to help make the diagnosis, ideally before 5 months of age.The diagnosis of CP is made when an infant has evidence of motor dysfunction as well as either abnormal neuroimaging or a clinical history suggestive of risk.

If a clinician suspects CP but is unsure of the diagnosis, Novak and colleagues (2017) recommend the use of the label ‘‘high risk for CP’’ in place of more general terms like ‘‘high risk for developmental delay’’ so that children can be appropriately referred for CP-specific early intervention therapies.

About Dr. Jayaprakash

Asst. Prof. of Pediatrics, ICH. Institute of Child Health. Gov. Medical College Kottayam. Kerala, India.

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