Early detection of cerebral palsy in high-risk infants: diagnostic value of primitive and developmental reflexes as well as ultrasound

  • Setyo Handryastuti Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta https://orcid.org/0000-0001-6968-9780
  • Ghaisani Fadiana Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Sofyan Ismael Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Sudigdo Sastroasmoro Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Asril Aminulah Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Ferial Hadipoetro Idris Muhammadiyah University Medical School, Jakarta
  • Adji Saptogino Radiology Department, Pondok Indah Hospital, Jakarta
  • Sunartini Hapsara Department of Child Health, Gadjah Mada University Medical School/Dr. Sardjito Hospital, Yogyakarta, Central Java
Keywords: early detection, cerebral palsy, cerebral ultrasound, motor delay, postural reaction, primitive reflex

Abstract

Background The incidence of cerebral palsy (CP) has increased due to better survival of high-risk babies. A simple assessment method is needed for the early detection of CP, which can be performed by general practitioners and pediatricians in daily practice.

Objectives To assess motor delay, primitive and developmental reflexes, and cerebral ultrasound abnormalities as simple methods for early detection of CP in high-risk infants. We also aimed to evaluate the ease and consistency of the methods for use in daily practice, as well as determine risk factors associated with CP.

Methods A prospective cohort study was done on 150 high-risk babies starting from the age of 4 months up to 12 months. We obtained subjects’ histories of motor ability and assessed primitive reflexes and postural reactions at the ages of 4, 6, 9 and 10 months. The diagnosis of CP was established at 6 and 12 months of age. We also determined Kappa test for inter-rater reliability between pediatric residents and pediatric neurologist.

Results In 88.7% of subjects, CP was detected in the first 6 months. At 4 months, positive palmar reflex, head lag, and fisting were predictive of CP at 6 months of age. Motor delay, positive palmar grasp reflex, head lag, fisting, and absent protective extension reflex at 6 months were predictive of CP at 12 months. At 9 to 10 months, motor delays, absent protective extension reflex, and negative parachute reaction were predictive of CP at 12 months. Cerebral ultrasound abnormalities were predictive of CP at 6 and 12 months of age. Kappa test result was 0.9, indicating the ease and consistency of these methods for daily medical practice.

Conclusion Cerebral palsy can be detected as early as the first 6 months of life. Assessment for motor delays, physical examination for asssessing primitive and developmental reflexes, and cerebral ultrasound can be used for this purpose.

References

1. Oskoui M, Shevell MI, Swaiman KF. Cerebral palsy. In: Swaimann KF, Ashwal S, Ferriero DM, Schor NF, Finkel RS, Gropman AL, Pearl PL, Shevell MI, editors. Pediatric neurology principles and practice. 6th ed. Philadelphia: Mosby Elsevier; 2017. p. 734-4.
2. Vincer MJ, Allen AC, Joseph KS, Stinson DA, Scott H, Wood E. Increasing prevalence of cerebral palsy among very preterm infants: a population based study. Pediatrics. 2006;118:e1621-6.
3. Cooley WC, American Academy of Pediatrics Committee on Children with Disabilities. Providing a primary care medical home for children and youth with cerebral palsy. Pediatrics. 2004;114:1106-13.
4. Illingworth RS. The diagnosis of cerebral palsy in the first year of life. Dev Med Child Neurol. 1966;8:178-94.
5. Palmer FB. Strategies for the early diagnosis of cerebral palsy. J Pediatr. 2004;145:S8-11.
6. Hadders-Algra M. General movements: a window for early identification of children at high risk for developmental disorders. J Pediatr. 2004;145:S12-S8.
7. Toet MC, Hellstrom-Westas L, Groenendaal F, Eken P, de Vries LS. Amplitude-integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 1999;81:F19-23.
8. Zafeiriou DI, Tsikoulas IG, Kremenepoulos GM. Prospective follow-up of primitive reflex profiles in high-risk infants: clues to an early diagnosis of cerebral palsy. Pediatr Neurol. 1995;13:148-52.
9. Shapiro BK. Cerebral palsy: a reconceptualization of the spectrum. J Pediatr. 2004;145:S3-7.
10. Volpe JJ. Intracranial hemorrhage: Germinal matrix-intraventricular hemorrhage of the premature infant. In: Volpe JJ, editor. Neurology of the newborn. 5th ed. Philadelphia: Saunders Elsevier; 2008. p. 517-73.
11. Cools F, Askie LM, Offringa M. Elective high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome: an individual patient data meta-analysis. BMC Pediatr. 2009;9:33-9.
12. Dani C, Bertini G, Pezzati M, Cecchi A, Caviglioli C, Rubaltelli FF. Early extubation and nasal continuous positive airway pressure after surfactant treatment for respiratory distress syndrome among preterm infants <30 weeks' gestation. Pediatrics. 2004;113:e560-3.
13. Ito T, Hashomoto K, Kadowaki K, Nagata N, Makio A, Takahashi H, et al. Ultrasonographic findings in the periventricular region in premature newborns with antenatal periventricular leukomalacia. J Perinat Med. 1997;25:180-3.
14. Boal DK, Watterberg KL, Miles S, Gifford KL. Optimal cost-effective timing of cranial ultrasound screening in low-birth-weight infants. Pediatr Radiol. 1995;25:425-8.
15. Pinto-Martin JA, Riolo S, Cnaan A, Holzman C, Susser MW, Paneth N. Cranial ultrasound prediction of disabling and nondisabling cerebral palsy at age two in low birth weight population. Pediatrics. 1995;95:249-54.
16. Volpe JJ. Hypoxic-ischemic encephalopathy: clinical aspects. In: Volpe JJ, editor. Neurology of the newborn. 5th ed. Philadelphia: Saunders Elsevier; 2008. p. 517-73.
17. Miller SP, Ramaswamy V, Michelson D, Barkovich AJ, Holshouser B, Wycliffe N, et al. Patterns of brain injury in term neonatal encephalopathy. J Pediatr. 2005;146:453-60.
18. Accardo J, Kammann H, Hoon AH. Neuroimaging in cerebral palsy. J Pediatr. 2004;145:S19-27.
19. Morgan AM, Aldag JC. Early identification of cerebral palsy usiang a profile of abnormal motor patterns. Pediatrics. 1996;98:692-7.
20. Zafeiriou DJ, Tsikoulas IG, Kremenepoulos GM, Kontopoulos EE. Using postural reactions as a screening test to identify high-risk infants for cerebral palsy: a prospective study. Brain Dev. 1998;20:307-11.
21. Georgieff MK, Bernbaum JC, Hoffman-Williamson M, Daft A. Abnormal truncal muscle tone as a useful early marker for developmental delay in low birth weight infants. Pediatrics. 1986;77:659-63.
22. Hadders-Algra M. Development of postural control. In: Hadders-Algra M, Carlberg EB, editors. Postural control: a key issue in developmental disorders. 1st ed. London: McKeith Press; 2008. p. 22-73.
23. Swaimann KF. Neurologic examination after the newborn period until 2 years of age. In: Swaimann KF, Ashwal S, Ferriero DM, Schor NF, Finkel RS, Gropman AL, Pearl PL, Shevell MI, editors. Pediatric neurology principles and practice. 6th ed. Philadelphia: Mosby Elsevier; 2017. p. 37-46.
Published
2018-03-20
How to Cite
1.
Handryastuti S, Fadiana G, Ismael S, Sastroasmoro S, Aminulah A, Idris F, Saptogino A, Hapsara S. Early detection of cerebral palsy in high-risk infants: diagnostic value of primitive and developmental reflexes as well as ultrasound. PI [Internet]. 20Mar.2018 [cited 5Oct.2024];58(1):5-2. Available from: https://www.paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1750
Section
Articles
Received 2018-01-02
Accepted 2018-02-15
Published 2018-03-20