Riassunto analitico
Background: According to the latest World Health Organization’s estimates 1 in 10 children is born premature. Due to the progress of perinatal medicine and neonatal care in recent decades, a significant increase in the survival rates of these children has been seen. This has inevitably generated a growing concern about the simultaneous increase in morbidity rates, especially neurological deficits and among them in particular cerebral palsy (CP). The early diagnosis of CP is as important as it is complex, because of the variability of risk factors and the heterogeneity of clinical forms. The age at which it is possible to make a correct diagnosis is very debated: this is usually placed at 24 months of correct age, but for several years we are studying systems to detect earlier the existence of the disease, in order to provide children and families with a specific rehabilitation plan. On the other hand, since diagnostic errors are not commonly detected until later ages, it would be desirable to be able to assess the diagnostic accuracy of these measurements even at ages older than 2 years.
Aim: Our first aim was to reassess the early signs of cerebral palsy already known to the international literature and to understand whether the study of their association and their evolution over time could increase their predictive power. Our second aim was to evaluate the correlation between these early signs of cerebral palsy and the outcomes in the medium-long term.
Methods: A total of 60 newborns were enrolled. 30 of these were included in the high risk group and 30 in the low risk group. For all children an evaluation of the MRI at term was made. Then the videotapes carried out in the course of the neurological follow-up were blindly examined. In this context, the trajectories of the general movements (GMs) and the concurrent motor repertoire were evaluated. Subsequently we carried out a medium and long-term follow up, checking whether the diagnosis of CP made at 2 years had been confirmed even in pre-school (3-5 years) and school age (6-12 years).
Results: Of 30 high-risk children (mean gestational age 27,6 weeks; mean birthweight 1132 g), 11 had tetraplegic CP, 11 diplegic CP and 8 hemiplegic CP at 2 years. 12 children were in GMFCS level I, 3 in level II, 3 in level III, 8 in level IV, and 2 in level V. As regards the predictive power, while some of the items examined proved to be definitely pathological (CS repertoire, absence of fidgety, poor MTM, poor hand/digit movements, dominant ATN, repetitive limbs movements, pendular head movements), only a different temporal trend between the two groups has been identified for others (postural instability, finger spreading). As far as the medium-long-term outcome is concerned, the 2-year diagnosis was confirmed in 70% of cases at pre-school and school age, while in 10% the diagnosis was modified with another type of CP. Of the remaining cases, in 6.7% it was not possible to find the data, while in 13% the diagnosis was replaced with that of minor neurological disorder/developmental coordination disorder, whereas only one case resulted normal in subsequent follow up checks.
Conclusion: If these early signs of cerebral palsy have reconfirmed significantly predictive, even more so is the association between them. This, in fact, allow us to differentiate those cases that on the basis of the observation of the GMs and the fidgety could remain of uncertain significance and to predict more accurately what could be the degree of functional impairment at short, medium and long-term.
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