Disclosures: Elizabeth Chan, MD: No financial relationships or conflicts of interest

Objective: Recent recommendations call for earlier detection and intervention for cerebral palsy (CP).The Hammersmith Infant Neurological Examination (HINE) is one standardized clinical tool that assists in predicting risk. To align our practice within these recommendations, we evaluated the feasibility of implementing an early detection management algorithm utilizing the HINE in our Neonatal Follow Up Program (NFP).

Design: Quality Improvement.Setting : Outpatient NFPParticipants : 342 infants seen in the NFP between January-December 2019.

Interventions: We developed a HINE algorithm for all three to five month corrected age (CA) visits. The algorithm risk stratifies infants into three groups based on HINE score: “at risk,” “sub-optimal,” and “normal.” Referrals for physical therapy (PT) and the physiatry team embedded within our clinic are included in the algorithm. We initiated the HINE in January 2019 after the lead physicians received training. Additional HINE training sessions for physical therapists and clinic physicians occurred in April and July 2019. In June 2019, a monthly workgroup formed to review our practice and compliance with the HINE algorithm.

Main Outcome Measures: HINE Compliance, compliance with referral to PT as per algorithm, compliance with referral to physiatry as per algorithm, Median HINE score, number of cerebral palsy diagnoses

Results: From January to December 2019, our compliance rate with performing the HINE at the 3-5 month CA visit was 91.2% (312/342). 8.8% of tests were not done/documented (30/342) and 5.0% (17/342) were incomplete. 4.7% (14/295) of infants with complete HINEs were “at risk” for CP. Of these, 85.7% (12/14) were referred to our physiatry team and 100% were referred to therapies, as suggested by the algorithm.Conclusions: It is feasible to incorporate the recommended clinical measures for CP early detection and intervention within a multidisciplinary NFP. Next steps include utilizing the HINE as a screening tool to perform the General Movements Assessment for infants at high risk for CP.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/filling-in-the-gaps-to-early-detection-of-cerebral-palsy-and-treatment-within-a-neonatal-follow-up-program/