Clinical characteristics influencing timing of cerebral palsy diagnosis in neonatal follow-up

Objectives: To describe clinical characteristics influencing the timing of cerebral palsy (CP) diagnosis in a traditional neonatal follow-up clinic (NFC) setting. Methods: Retrospective observational cohort study involving preterm infants, born <29 weeks gestation and/or birthweight <1000 g between January 2005 and December 2014, with CP and followed in Calgary's NFC. Infant data were collected, including demographics, perinatal and neonatal parameters, cranial ultrasound (cUS) results, co-occurring conditions, and CP characteristics (timing of suspicion and diagnosis, type, topography, distribution, and Gross Motor Function Classification System [GMFCS] level). This cohort was divided into two groups, early (diagnosed <19 months corrected age [CA]) and late (diagnosed >= 19 months CA), based on the median age of CP diagnosis, and characteristics were compared. Results: A total of 99 infants met the inclusion criteria. Median age at first CP suspicion was 9 months CA (interquartile range [IQR] 14) and median age at diagnosis was 19 months CA (IQR 17), with median time lag from suspicion to diagnosis of 6 months (IQR 12). CP characteristics associated with diagnosis at an earlier age included higher GMFCS level, mixed type (compared to spastic only), and upper and lower extremities involvement. Infant characteristics, severity of cUS results, and co-occurring conditions were not different between early and late groups. Conclusions: CP diagnosis timing is affected by GMFCS level, motor type, and distribution. Especially in infants with CP involving less motor impairment, there is a prolonged delay between CP suspicion and formal diagnosis. This gap may be amenable to quality improvement initiatives aimed at targeted implementation of early assessment tools.