Early detection of cerebral palsy in high-risk infants: diagnostic value of primitive and developmental reflexes as well as ultrasound
Abstract: 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.
Keywords: early detection;
cerebral palsy; cerebral ultrasound; motor delay; postural reaction; primitive
reflex
Author: Setyo Handryastuti,
Ghaisani Fadiana, Sofyan Ismael, Sudigdo Sastroasmoro, Asril Aminulah, Ferial
Hadipoetro Idris, Adji Saptogino, Sunartini Hapsara
Journal Code: jpkedokterangg180020
