Neonatal follow-up clinics support early identification of cerebral palsy

Background: Cerebral palsy is the most common form of childhood physical disability. Recent international expert panels and diagnostic guidelines have highlighted the importance of early identification and intervention in cases of cerebral palsy. Early identification allows children to receive cerebral palsy-specific interventions during critical developmental windows, optimizing opportunities for functional improvements. The Glenrose Rehabilitation Hospital has developed a close alliance with neonatal follow-up clinics (NNFCs) in Northern Alberta to support earlier identification of children at high risk of a cerebral palsy diagnosis. In this study, we investigated whether referral to a NNFC was associated with earlier diagnosis and initiation of rehabilitation services for children with cerebral palsy in Northern Alberta.

Methods: Three hundred and sixty-one children with cerebral palsy born between 2007 and 2019 were identified through the Canadian Cerebral Palsy Registry. All participants received services at the Glenrose Rehabilitation Hospital. One hundred and thirty-one (36.2%) were referred to a NNFC after discharge from the neonatal intensive care unit. The remaining 230 (63.7%) received usual care. Retrospective chart reviews were conducted for each child to identify Gross Motor Functional Classification System (GMFCS) scores, age at diagnosis, and age at initiation of rehabilitation services. Independent samples t-tests were used to compare age at clinical care timepoints across groups.

Results: Of children referred to NNFC, 48.0% were not independently ambulatory (GMFCS ≥ III), relative to 27.9% of children receiving usual care. Children referred to NNFC were diagnosed with cerebral palsy at a significantly younger age (M=18.57 months, SD=8.33 months) than children receiving usual care (M=21.79 months, SD=13.64 months; t(216.043)=2.194, p=0.029). Likewise, children referred to NNFC began receiving rehabilitation services at a significantly younger age (M=8.29 months, SD=5.23 months), than children receiving usual care (M=18.36 months, SD=13.69 months; t(142.899)=5.521, p=0.000).

Conclusions: In this study, we found an association between follow-up at an NNFC and earlier achievement of clinical care timepoints for children with cerebral palsy in Northern Alberta. These findings should be interpreted with caution. Children with greater gross motor impairment were over-represented in the NNFC sample, which may bias NNFC participants to earlier identification. However, the significant differences found here suggest that the Glenrose Rehabilitation Hospital’s collaboration with Northern Alberta NNFCs has produced a pathway towards earlier identification and intervention for children with cerebral palsy.