规范高危婴儿早期脑瘫检测：通过质量改进举措降低诊断年龄。
Standardizing early cerebral palsy detection in high-risk infants: reducing age at diagnosis through a quality improvement initiative.
作者信息
Ryder Sylvan, Kerner-Rossi Mallory, Brachio Sandhya, Yoon Lisa, Brennan Kathleen, Hammond Jennifer, Paskin Gabriella, Zygmunt Annette, Abreu Anketil, O'Neill Shelagh, Ryan Patricia, Wagner Joan, Penn Anna, Kim Faith
机构信息
Columbia University Medical Center, New York, NY, USA.
NewYork Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
出版信息
J Perinatol. 2025 Sep 9. doi: 10.1038/s41372-025-02412-z.
OBJECTIVE
To screen high-risk infants for CP in a level IV NICU and high-risk infant follow-up (HRIF) clinic.
STUDY DESIGN
By using quality improvement methodology, we implemented the General Movement Assessment (GMA) and Hammersmith Infant Neurological Examination (HINE) to screen for CP and lower age at diagnosis. Main balancing measures included no-show rates.
RESULTS
Within the first year, 89% of infants had a GMA in the NICU, 100% in HRIF and 87% had a HINE in HRIF. Median age at diagnosis decreased from 18.5 months adjusted [16.7,19.4] in 2021 to 7.5 months [5.9,14.4; p = 0.01] in 2022 and 8.9 months [6.6,12.2; p = 0.01] in 2023. No-show rates increased in 2022 compared to 2021 (24% vs 17%, p = 0.02).
CONCLUSIONS
By implementing and continuously improving a standard process in the NICU and HRIF, we demonstrated a successful increase in screening for CP leading to a lower age at diagnosis sustained for two years.
目的
在四级新生儿重症监护病房（NICU）和高危婴儿随访（HRIF）诊所中筛查脑瘫高危婴儿。
研究设计
通过运用质量改进方法，我们实施了全身运动评估（GMA）和哈默史密斯婴儿神经学检查（HINE），以筛查脑瘫并降低诊断年龄。主要平衡指标包括失访率。
结果
在第一年，89%的婴儿在NICU接受了GMA评估，在HRIF中这一比例为100%，87%的婴儿在HRIF接受了HINE评估。诊断时的中位年龄从2021年调整后的18.5个月[16.7,19.4]降至2022年的7.5个月[5.9,14.4；p = 0.01]以及2023年的8.9个月[6.6,12.2；p = 0.01]。与2021年相比，2022年的失访率有所上升（24%对17%，p = 0.02）。
结论
通过在NICU和HRIF中实施并持续改进标准流程，我们成功提高了脑瘫筛查率，使诊断年龄降低并持续了两年。
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