Browsing by Subject "High-risk infants"

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    Hammersmith Infant Neurological Examination Subscores are Predictive of Cerebral Palsy
    (Elsevier, 2024) Kapil, Namarta; Majmudar-Sheth, Bittu; Johnson, Tara; Neurology, School of Medicine
    Background: The Hammersmith Infant Neurological Examination (HINE) is a standardized assessment that identifies early signs of cerebral palsy (CP). In practice, the clinician performs this assessment in its entirety, yielding a global score. This study aimed to investigate the individual HINE subscores and "asymmetries" as predictive indicators of CP. Methods: In this retrospective nested case-control study, a pediatric neurologist performed the HINE on a cohort of three- to four-month-old former neonatal intensive care unit infants. The infants' neurodevelopmental outcomes were determined by chart review when they were aged two to three years. We performed univariate and multivariable logistic regression analyses to yield the accuracy of the global HINE score, HINE subscores, and "asymmetries" in classifying infants with and without CP. Results: Of the 108 infants on whom HINE was performed, 50 were either discharged due to normal developmental progress or were lost to follow-up. Of the remaining 58 subjects, 17 had CP and 41 did not. Receiver operator characteristic (ROC) curves of univariate models yielded the following area under the curve (AUC) scores: global HINE score (AUC = 0.75), "reflexes and reactions" (AUC = 0.80), "cranial nerve function" (AUC = 0.76), "asymmetries" (AUC = 0.75), and "movements" (AUC = 0.71). The ROC for our multivariable model (AUC = 0.91) surpassed the global HINE score's predictive value for CP. Conclusions: The weighted combination of HINE subscores and "asymmetries" outperforms the global HINE score in predicting CP. These findings suggest the need for revisiting HINE, but further validation with a larger dataset is required.
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    Unveiling the Immediate Impact of Prechtl’s General Movement Assessment Training on Inter-Rater Reliability and Cerebral Palsy Prediction
    (MDPI, 2024-07-23) Kapil, Namarta; Majmudar-Sheth, Bittu; Escapita, Alexa Celeste; Johnson, Tara; Neurology, School of Medicine
    Prechtl's General Movement Assessment (GMA) is a qualitative video assessment that is an early predictor of cerebral palsy (CP) in infants. GMA raters undergo two levels of training: basic and advanced. Using a retrospective study design, we evaluated the impact of the GMA training level on three key measures: inter-rater reliability (IRR), predictability for a later CP diagnosis, and generalizability for both medically trained and non-medically trained raters. As part of a larger study on former level-IV neonatal intensive care unit (NICU) infants, participants had a GMA video at 3-4 months of corrected age with parental consent. Four GMA raters with basic training interpreted the videos. Subsequently, two raters underwent advanced training and reinterpreted the videos. We evaluated IRR with Gwet's AC1 coefficient, CP prediction with logistic regression, and generalizability with Gwet's Linearization method and McNemar's test. Following basic GMA training, all four raters had moderate to almost perfect agreement. The CP predictability of the raters' individual GMA scores ranged from 73% to 81%. Advanced GMA training significantly improved IRR and enhanced CP predictability. GMA rater proficiency was similar regardless of medical training. Advanced GMA training improved readers' capabilities to correctly identify abnormal movement patterns and aid in early CP diagnosis.