735 - Implementation of Early Detection for Cerebral Palsy Guidelines in the NICU Setting

Publication Number: 2717.735

Tanu Patel, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Christiana D. Butera, University of Southern California Division of Biokinesiology, LOS ANGELES, CA, United States; Amy Paz, Olive View UCLA Medical Center, Sylmar, CA, United States; Ashwini Lakshmanan, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States; Shannon M. Thyne, Olive View-UCLA Medical Center, Sylmar, CA, United States; Stacey Dusing, University of Southern California Biokinesiology and PT - Motor Development Lab, Los Angeles, CA, United States; Amy Yeh, USC/Los Angeles General Medical Center, Los Angeles, CA, United States

Background: Traditionally, cerebral palsy (CP) has been diagnosed at about two years of age. Evidence based guidelines published in 2017 outline that with use of the Generalized Movement Assessment (GMA), Hammersmith Infant Neurologic Exam (HINE), Test of Infant Motor Performance (TIMP), and Brain MRI, CP can be diagnosed before 5 months corrected gestational age. Using these screening tools, evaluation for cerebral palsy can begin in the neonatal intensive care setting. Earlier detection of infants at risk for CP allows for closer High Risk Infant Follow-Up (HRIF) and more prompt implementation of therapeutic interventions, such as physical therapy and occupational therapy, which can mitigate the developmental effects of CP.

Objective: This study aims to test the feasibility and effectiveness of implementing screening guidelines in the level neonatal intensive care unit of a public safety net hospital.

Design/Methods: HRIF eligible neonates admitted to the Los Angeles General Medical Center starting May 1st, 2025 were screened by GMA. They were additionally evaluated for MRI indication and TIMP were requested on their behalf. NICU fellows and residents requested studies for eligible patients. GMA assessments were filmed and read by a NICU fellow and HRIF attending. TIMP assessments were performed by Physical Therapy staff.

Results: A total of 24 neonates born at Los Angeles General Medical Center met criteria for screening with a range of 24 to 41 weeks and average of 31.3 weeks. The majority met inclusion criteria due to gestational age with three infants meeting criteria for sepsis. One infant had electrographically diagnosed seizures. Seven infants had MRI Brain imaging performed either due to gestational age < 30 weeks, diagnosis of meningitis, or diagnosis of hyperbilirubinemia. Nine infants had at least one TIMP performed, and five of these infants had repeat TIMP. All 24 infants had at least one GMA performed. Of these patients, five had normal GMA’s and an additional four had initial findings of poor repertoire which later normalized. 15 had findings of poor repertoire on initial screen and persistently. 58% of these infants have been seen in HRIF clinics, two have received fidgety age GMA screening thus far.

Conclusion(s): NICU based GMA and MRI screening is feasible even in a low resource setting. Engagement of physical therapy staff to perform TIMP remains a challenge. We met implementation metrics by 100% in the GMA, 38% in TIMP, and 100% in MRI. In future PDSA cycles, we will have formal training for providers to improve engagement with this process and communication of results to families.