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Volume 4
Neonatal and Pediatric Medicine
Pediatrics Neonatal Care 2018
November 12-13, 2018
Page 38
conference
series
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November 12-13, 2018 Dubai, UAE
22
nd
World Congress on
Pediatrics, Neonatology & Primary Care
Diagnostic assessment of cerebral palsy and other neurodevelopmental disorders after NICU: Do not
wait-and-see
W
orldwide, Cerebral Palsy (CP) is the most common motor disability in childhood. CP is the result of a non-progressive lesion
or injury to developing brain and has multiple causes and clinical manifestations, which leads to a very challenging discussion
on diagnosis and screening. CP registers indicate the average age at cerebral palsy diagnosis is 19 months of age, however in most
clinical settings the age of CP diagnosis is on average two years or older. It is well-known that delays in diagnosis of cerebral palsy are
associatedwithworse long-termmotor function, parental dissatisfaction and higher rates of physical andmental health deterioration.
Infants at high risk for neurodevelopmental disorders, including CP, can be identified early, in the first weeks of life, through
systematic clinical evaluation combined with specific neuroimaging, neurophysiological tests and when needed genetic testing. The
most promising early predictive tool for CP is the General Movement’s Assessment (GMA), which assesses the quality of spontaneous
movements of infants in the first 4 months of life. However, as not all children with abnormal findings at neurological examination
or on neuroimaging will develop CP, several authors recommend combining GMA with MRI. This combined assessment has been
showing high sensitivity and specificity starting from the first months of life (GMA, 98% and 91%; MRI performed at term 86-
100% and 89-97%, respectively). As stated by the World Health Organization, identification of the infant at risk for CP and others
neurodevelopmental disorders is a crucial starting point to establish a close relationship between parents and health care providers
and to provide early intervention. The broad goal of early intervention is to minimize motor, cognitive, emotional impairments,
therefore the remarkable potential of the brain development between preterm age and the age of 1-year post-term offer the best
opportunity for early intervention. Hence, ideally early intervention should beginwhen infants are still in the Neonatal Intensive Care
Unit (NICU), mainly by focusing on reduction/minimization of stress factors or soon after NICU discharge. Nevertheless, the main
aimof early intervention after hospital discharge is no longer stress reduction but supporting the infant’s development and functional
outcomes. Certainly, the best practice will involve comprehensivemultidisciplinary programs based on active interventions including
physiotherapy, occupational therapy, psychology and neurodevelopmental management. Brain and muscle plasticity in response
to target therapies has been demonstrated in children with CP of different age ranges, confirming that neuroplasticity is a lifelong
continuous process that enables the brain to change and rewire itself in response to stimulation. However, clinical and experimental
findings seem to indicate that, to be maximally effective, early intervention has to be early, intensive, active, individualized and
family based. Therefore, the main goal of early motor training is to optimize the development of skilled motor function and avoid
musculoskeletal deformities. Poor control of muscles and movement in children with CP can be associated with a wide range of
functional challenges. Traditional efforts to manage these motor disabilities have been directed at improving tone and promoting
adequate motor patterns. However, contemporary approaches are directed rather to target muscle weakness and poor selective motor
control, which is showing very encouraging results. Given that cerebral palsy presents at early in infancy and persists throughout
lifetime, effective management must be cost efficient, family friend and based in context of community integration.
Biography
Simone Battibugli is a Pediatric Orthopedic Surgeon, currently working as Pediatric Orthopedic Surgeon at The Children’s Medical Centre in Dubai. She has 10
years clinical and research experience as Faculty of Federal University of Sao Paulo. She has completed her Pediatric Orthopedic Fellowship training at Children's
Hospital, Chicago, USA and also as a Fellow at Shriners Hospital for Children. Lexington, USA. Her main interest is in evidence based medicine, systematic
literature review, management and clinical research on neuromuscular disorders, as cerebral palsy, spina bifida and arthrogryposis multiplex congenital and
congenital foot and lower limb deformities and other congenital and acquired musculoskeletal pathologies in children.
Simone Battibugli
The Children’s Medical Centre, UAE
Simone Battibugli, Neonat Pediatr Med 2018, Volume 4
DOI: 10.4172/2572-4983-C3-008