Early prediction of cerebral palsy after neonatal intensive care using motor development trajectories in infancy

Neonatal intensive care unit (NICU) patients are at high risk for developmental disabilities such as cerebral palsy (CP). Early identification of CP is essential to effective rehabilitation, but diagnosis is often delayed, especially in preterm infants. We hypothesized that through the longitudinal evaluation of motor trajectories in the NICU follow-up clinic, we could distinguish infants who develop CP by 3. years of age. Study design and subjects: This was a retrospective study of 606 patients in the NICU Follow-up Clinic at Vanderbilt University with birth weight < 1500g or a diagnosis of hypoxic ischemic encephalopathy. Outcomes measures: Assessments included neurologic exams, the Developmental Assessment of Young Children (DAYC), the Bayley Scales of Infant Development (BSID) and the Gross Motor Function Classification Scale. Results: A decrease in DAYC scores between 6 and 12. months was present in preterm and term infants later diagnosed with CP, but not in children without CP (-23 vs. + 1.5, p<0.001) DAYC score decreases in infancy were highly predictive of later CP (p<0.001). BSID scores quantified severe motor delays but did not add to prediction of CP diagnosis. Conclusion: Standardized assessments of motor milestones quantitatively predict the risk of CP in former NICU patients by 12. months, allowing for timely diagnosis, counseling and therapy in high-risk infants.