Implementation of the state-wide Queensland Early Detection Network (QEDIN-CP) -Prediction of outcomes for infants at risk of adverse neurodevelopmental outcomes

Abstract

Introduction: The QEDIN-CP network supports implementation of the CP early detection guidelines; providing training, support for early screening, to fast-track infants to early intervention. This study evaluates the relationship between screening and outcomes in a prospective cohort of infants at risk of CP or adverse neurodevelopmental outcomes (NDO). Patients and methods: 574 clinicians, across 18 sites, were trained in (1) General Movements Assessment (GMA; n = 246) (2) Hammersmith Infant Neurological Examination (HINE; n = 328), over a 5-year period. Infants were screened at 0-12 months corrected age (CA) using GMA, Motor Optimality Score (MOS) and HINE with outcomes at 24 months CA on Ages and Stages Questionnaire (ASQ-3) and/or paediatrician diagnosis, classified as (a) typically developing, (b) CP or (c) adverse NDO (<2SD on ASQ-3). Results: 770 infants were referred with 637 (83%) consented, 439 (69%) were born preterm (mean GA = 33 wks) with 116 (18%) extreme preterm. Of these 46 3(73%) completed GMA, (n = 184, 40% writhing, n = 432, 93% fidgety), with 308 (71.3%) normal, 18 (4.2%) abnormal and 106 (24.5%) absent fidgety. At 3-12 months 290 (45%) infants completed HINE assessments (mean = 57.5, SD = 12.5). 95 (15%) infants received a diagnosis of CP at any age. Of 200 (87.7%) infants with completed outcomes, a further 37 (18%) were “high risk of CP” at 24 months. 118 (19%) infants were fast-tracked to early intervention studies. Conclusion: Large scale implementation of the CP early detection guidelines is feasible utilising a collaborative state-wide approach and clinical support network providing training, second opinions and calibration sessions. Early identification of high-risk infants promotes early access to CP specific supports and services..