Early Recognition of Infants at High Risk for Cerebral Palsy: Examination at Age Four Months

Abstract

More than 32,000 children in a prenatally-defined cohort were examined 4 mo. after birth, and were re-examined at the age of 7 yr to determine the presence of cerebral palsy. Observations from the examination at 4 mo. were investigated as predictors of cerebral palsy, and the most reliable individual sign was increased muscle tone in neck, arms, legs or trunk. On completion of the physical examination at 4 mo. the neurological status of each infant was assessed. Of the children considered to be normal, 1 in 1000 had cerebral palsy by the age of 7 yr, compared with 1 in 100 of those thought to be suspect. Of the children who were definitely neurologically abnormal at 4 mo., 1 in 7 had disabling cerebral palsy by early school-age. The predictive power of abnormal physical findings increased with the number of abnormal findings and with failure to meet motor milestones. Four mo. old infants who passed all milestone measures had a very low rate of later cerebral palsy, even if they had had abnormal physical findings. Examination of 4 mo. old infants permits the clinician to recognize children at widely different levels of risk of chronic motor handicap.