Department of Neurology and UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California; Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.
Department of Radiology, University of California San Francisco, San Francisco, California.
Pediatr Neurol. 2021 May;118:20-25. doi: 10.1016/j.pediatrneurol.2021.02.003. Epub 2021 Feb 15.
Cerebral palsy (CP) is the most common motor disability of childhood. Its early identification is an important priority for parents and is critical for access to early intervention resources, which may optimize function.
A prospective cohort of term neonates at high risk for CP was assessed by neonatal magnetic resonance imaging (MRI) to determine myelination of the posterior limb of the internal capsule, General Movements Assessment to assess typical fidgety movements at age three months, and followed to at least age two years to determine diagnosis of CP based on neurological examination.
Seven of 58 children developed CP (12%), two with moderate/severe CP. Sensitivity and specificity for abnormal myelination of the posterior limb of the internal capsule were (PLIC) was 29% and 94%, and for absent fidgety movements, 29% and 98%, respectively. Negative predictive value of both absent myelination of the PLIC and absent fidgety movements was 90% (79% to 96%) for any CP and 98% (90% to 100%) for moderate/severe CP cerebral palsy. None of the children with both normal PLIC and normal fidgety movements had moderate/severe CP.
Normal neonatal MRI and General Movements Assessment at age three months are reassuring that a high-risk term-born child is at low risk for moderate/severe CP. These results are important for counseling parents and individualizing therapy resources in the community.
脑瘫（CP）是儿童最常见的运动障碍。早期识别是父母的重要优先事项，对于获得早期干预资源至关重要，这可能优化功能。
对有 CP 高风险的足月新生儿进行前瞻性队列研究，通过新生儿磁共振成像（MRI）评估后肢内囊的髓鞘形成，通过一般运动评估评估三个月大时典型的烦躁运动，并随访至少两年，根据神经检查确定 CP 的诊断。
58 名儿童中有 7 名（12%）发展为 CP，其中 2 名患有中度/重度 CP。后肢内囊髓鞘形成异常（PLIC）的敏感性和特异性分别为 29%和 94%，而烦躁运动异常的敏感性和特异性分别为 29%和 98%。PLIC 无髓鞘形成和无烦躁运动均阴性的预测值分别为任何 CP 的 90%（79%至 96%）和中度/重度 CP 的 98%（90%至 100%）。没有一个 PLIC 和烦躁运动均正常的儿童患有中度/重度 CP。
正常的新生儿 MRI 和三个月大时的一般运动评估令人安心，表明高危足月出生的儿童患中度/重度 CP 的风险较低。这些结果对于为父母提供咨询和在社区中个性化治疗资源非常重要。
