Standardizing early cerebral palsy detection in high-risk infants: reducing age at diagnosis through a quality improvement initiative

Abstract

Objective: To screen high-risk infants for CP in a level IV NICU and high-risk infant follow-up (HRIF) clinic. Study Design: By using quality improvement methodology, we implemented the General Movement Assessment (GMA) and Hammersmith Infant Neurological Examination (HINE) to screen for CP and lower age at diagnosis. Main balancing measures included no-show rates. Results: Within the first year, 89% of infants had a GMA in the NICU, 100% in HRIF and 87% had a HINE in HRIF. Median age at diagnosis decreased from 18.5 months adjusted [16.7,19.4] in 2021 to 7.5 months [5.9,14.4; p = 0.01] in 2022 and 8.9 months [6.6,12.2; p = 0.01] in 2023. No-show rates increased in 2022 compared to 2021 (24% vs 17%, p = 0.02). Conclusions: By implementing and continuously improving a standard process in the NICU and HRIF, we demonstrated a successful increase in screening for CP leading to a lower age at diagnosis sustained for two years.