MRI, General Movements, and Neurological Examination for Early Cerebral Palsy Diagnosis in Preterm Infants

BACKGROUND AND OBJECTIVES: Researchers have not yet collected sufficient prognostic data on the combined use of structural brain MRI (sMRI) with General Movements Assessment (GMA) or Hammersmith Infant Neurological Examination (HINE) in children born preterm for diagnosing cerebral palsy (CP) before 5 months corrected age (CA), particularly for Gross Motor Function Classification System (GMFCS) level I CP. We evaluated the predictive values of sMRI, GMA, and HINE individually and in combination for early CP diagnosis and assessed accuracy across varying GMFCS levels in children born preterm. METHODS: We studied a prospective regional cohort of 395 preterm infants (≤32 weeks' gestation) from 5 NICUs in Greater Cincinnati. The primary outcome was CP diagnosis at 22 to 26 months CA, classified by GMFCS. We calculated sensitivity, specificity, predictive values, and likelihood ratios for CP diagnosis/prediction for an abnormal sMRI (motor tract abnormalities) at 39-44 weeks postmenstrual age and an abnormal GMA (absent fidgety movements) or HINE (score below 56) at 12 to 18 weeks CA. RESULTS: Of 338 (86%) children with complete follow-up, 39 (11.5%) developed CP (28 GMFCS level I, 11 levels II-V). Combining sMRI and GMA achieved 100% specificity and 22% sensitivity, while sMRI and HINE exhibited 32% sensitivity, 98% specificity. These 2 combinations achieved higher sensitivity (78%-90%) and specificity (98%-100%) for predicting CP levels II to V. CONCLUSIONS: In our preterm cohort, sMRI plus GMA/HINE demonstrated high specificity but low sensitivity in predicting CP, underscoring the need for longer developmental follow-up and more sensitive diagnostic tools for early detection of CP in children born preterm.