The Knowledge Translation of Early Cerebral Palsy (KiTE CP) Study: Implementing Screening Among a High-Risk Prospective Cohort of Australian Infants

Amanda K L Kwong; Abbey L Eeles; Peter J Anderson; Nadia Badawi; Roslyn N Boyd; Kate L Cameron; Jeanie L Y Cheong; Paul Colditz; Pieter Koorts; Cathryn Crowle; Russell C Dale; Lex W Doyle; Michael Fahey; Joanne George; Rod W Hunt; Lynda McNamara; Catherine Morgan; Iona Novak; Joy E Olsen; Nadia Reid; Ingrid Rieger; Koa Whittingham; Alicia J Spittle

doi:10.1016/j.jpeds.2024.113949

The Knowledge Translation of Early Cerebral Palsy (KiTE CP) Study: Implementing Screening Among a High-Risk Prospective Cohort of Australian Infants

J Pediatr. 2024 May:268:113949. doi: 10.1016/j.jpeds.2024.113949. Epub 2024 Feb 8.

Authors

Amanda K L Kwong¹, Abbey L Eeles², Peter J Anderson³, Nadia Badawi⁴, Roslyn N Boyd⁵, Kate L Cameron⁶, Jeanie L Y Cheong⁷, Paul Colditz⁸, Pieter Koorts⁹, Cathryn Crowle⁴, Russell C Dale¹⁰, Lex W Doyle⁷, Michael Fahey¹¹, Joanne George¹², Rod W Hunt¹³, Lynda McNamara¹⁴, Catherine Morgan¹⁵, Iona Novak¹⁰, Joy E Olsen¹⁶, Nadia Reid¹⁷, Ingrid Rieger¹⁸, Koa Whittingham¹⁹, Alicia J Spittle²⁰

Affiliations

¹ Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Newborn Research, Royal Women's Hospital, Parkville VIC, Australia.
² Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Newborn Research, Royal Women's Hospital, Parkville VIC, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
³ Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.
⁴ The Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, NS, Australia; Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, NS, Australia.
⁵ Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Australasian Cerebral Palsy Clinical Trials Network CRE, The University of Queensland, Brisbane, Australia.
⁶ Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia.
⁷ Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Newborn Research, Royal Women's Hospital, Parkville VIC, Australia; Department of Obstetrics, Gynaecology, and Newborn Health, University of Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
⁸ University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
⁹ Neonatology, Royal Brisbane Women's Hospital, Brisbane, Australia.
¹⁰ Faculty of Medicine and Health, The University of Sydney, Sydney, NS, Australia.
¹¹ Department of Paediatrics, Monash University, Melbourne, Australia.
¹² Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Physiotherapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
¹³ Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, NS, Australia; Monash Newborn, Monash Children's Hospital, Clayton VIC Australia.
¹⁴ Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Australasian Cerebral Palsy Clinical Trials Network CRE, The University of Queensland, Brisbane, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NS, Australia; Department of Physiotherapy, Cairns and Hinterland Hospital and Health Service, QLD, Australia.
¹⁵ Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, NS, Australia.
¹⁶ Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Newborn Research, Royal Women's Hospital, Parkville VIC, Australia.
¹⁷ Division of Newborn Services, Royal Hospital for Women, Sydney, NSW, Australia; Department of Physiotherapy, Sydney Children's Hospital, Randwick, NSW, Australia.
¹⁸ Faculty of Medicine and Health, The University of Sydney, Sydney, NS, Australia; Royal Prince Alfred Hospital, Camperdown, NS, Australia.
¹⁹ Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
²⁰ Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia; Newborn Research, Royal Women's Hospital, Parkville VIC, Australia. Electronic address: aspittle@unimelb.edu.au.

PMID: 38336205
DOI: 10.1016/j.jpeds.2024.113949

Abstract

Objective: To describe the implementation of the international guidelines for the early diagnosis of cerebral palsy (CP) and engagement in the screening process in an Australian cohort of infants with neonatal risk factors for CP.

Study design: Prospective cohort study of infants with neonatal risk factors recruited at <6 months corrected age from 11 sites in the states of Victoria, New South Wales, and Queensland, Australia. First, we implemented a multimodal knowledge translation strategy including barrier identification, technology integration, and special interest groups. Screening was implemented as follows: infants with clinical indications for neuroimaging underwent magnetic resonance imaging and/or cranial ultrasound. The Prechtl General Movements Assessment (GMA) was recorded clinically or using an app (Baby Moves). Infants with absent or abnormal fidgety movements on GMA videos were offered further assessment using the Hammersmith Infant Neurological Examination (HINE). Infants with atypical findings on 2/3 assessments met criteria for high risk of CP.

Results: Of the 597 infants (56% male) recruited, 95% (n = 565) received neuroimaging, 90% (n = 537) had scorable GMA videos (2% unscorable/8% no video), and 25% (n = 149) HINE. Overall, 19% of the cohort (n = 114/597) met criteria for high risk of CP, 57% (340/597) had at least 2 normal assessments (of neuroimaging, GMA or HINE), and 24% (n = 143/597) had insufficient assessments.

Conclusions: Early CP screening was implemented across participating sites using a multimodal knowledge translation strategy. Although the COVID-19 pandemic affected recruitment rates, there was high engagement in the screening process. Reasons for engagement in early screening from parents and clinicians warrant further contextualization and investigation.

Keywords: cerebral palsy; early detection; general movements assessment; high-risk infant.

Publication types

Research Support, Non-U.S. Gov't
Multicenter Study

MeSH terms

Australia
COVID-19 / diagnosis
COVID-19 / epidemiology
Cerebral Palsy* / diagnosis
Cohort Studies
Early Diagnosis
Female
Humans
Infant
Infant, Newborn
Magnetic Resonance Imaging
Male
Neonatal Screening / methods
Neuroimaging
Neurologic Examination / methods
Prospective Studies
Risk Factors
Translational Research, Biomedical*