The Prechtl’s General Movement Assessment, Hammersmith Infant Neurological Examination and Sensory Profile-2 in Prediction of Cerebral Palsy at Two Years of Age in High-risk Infants: A Retrospective Study

Abstract

Objective: The predictive values of the general movements assessment (GMA), the Hammersmith infant neurological examination (HINE), and the infant sensory profile-2 (ISP-2) were investigated for the diagnosis of cerebral palsy (CP) in high-risk infants at two years age. Methods: Thirty-four high-risk infants with a mean gestational age of 33.1±4.2, who were followed up in the physiotherapy unit after discharge from the neonatal intensive care unit, were recruited. Prechtl’s GMA results were collected for infants at 3rd month. The ISP-2 and HINE were used to evaluate neurological and sensory processing at 3rd month for once, respectively. A pediatric neurologist who was blinded to all testing made the diagnosis of CP at two years of age based on neuroimaging and clinical tests. The GMA, HINE, and ISP-2’s predictive values were assessed seperately and sequentially (with two and three stage testings). Results: The mean birth weight of the infants was 1993.7±889.3 grams (g), the 3rd month HINE and ISP-2 total score averages were 56.9±9.3 and 53.8±13, respectively. In order to diagnose CP, it was important to consider the predictive values of the GMA (absent FMs) (sensitivity: 100%; specificity: 96.15%, p<0.001; 95% confidence interval: 80.36-99.9), HINE (sensitivity: 87.5%; specificity: 80.77%; p=0.004), and the combination of both GMA and HINE (sensitivity: 87.5%; specificity: 100%; p<0.001). The combination of ISP-2, GMA, and HINE was significant in identifying CP diagnosis (sensitivity: 62.5%, specificity: 100%, p=0.002) despite the ISP-2’s unremarkable predictive performance (sensitivity: 75%, specificity: 61.54%, p=0.123). Conlusion: Early follow-up of high-risk of infants may enable early diagnosis of CP and referral to early intervention by clinical application and combination of GMA and HINE.

Keywords

• general movement assessment
• hammersmith infant neurological examination
• infant sensory profile-2
• cerebral palsy
• high risk infant