{
  "abstract": "Objective To evaluate the predictive validity of best practice early detection tools for cerebral palsy (CP) in a high-risk cohort.Study design Prospective longitudinal cohort study.Setting Neonatal intensive care unit of a regional tertiary hospital in Bangladesh.Participants Neonates with risk factors for CP admitted to Mymensingh Medical College Hospital Neonatal Intensive Care Unit between November 2019 and March 2020.Outcome measures General Movements Assessment (GMA) at writhing and fidgety periods; Hammersmith Infant Neurological Examination (HINE) and Peabody Developmental Motor Scales Second Edition (PDMS-2) conducted in person at 3, 12 and 24 months. The Developmental Assessment of Young Children (DAYC-2), Ages and Stages Questionnaire (ASQ-3) and Developmental Milestones Chart (DMC) were administered remotely at 6, 9, 12, 18 and 24 months. Due to the impact of COVID-19, a proportion of the cohort was not able to have GMA fidgety videos completed and the first HINE assessment was delayed.Results A total of 227 infants were enrolled. Of the surviving infants assessed at 24 months, 36 (29%) had a confirmed diagnosis of CP. The most accurate combination of tools for early detection was GMA and HINE at 3 months (sensitivity 0.91; specificity 1.00). The PDMS-2 Total Motor Quotient, with an optimised cut-off of 59, showed high accuracy at 24 months (sensitivity 0.94; specificity 0.99). Among the tools administered remotely, the DAYC-2 PD, DMC (Gross and Fine Motor domains) and ASQ-3 (Gross and Fine Motor domains) demonstrated strong predictive validity—both individually and in combination—at 9, 12, 18 and 24 months, supporting their use as practical alternatives when in-person assessments are not feasible.Conclusions Despite pandemic-related disruptions, an accurate diagnosis was possible as early as 3 months of age using the best practice tools. Our findings support the practicability of scalable early detection models integrating in-person and remote assessments to improve access to timely diagnosis.",
  "authors": [
    {
      "affiliations": [
        "Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia",
        "Children’s Hospital Westmead Clinical School, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia",
        "CSF Global, Dhaka, Bangladesh",
        "Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh"
      ],
      "name": "Tasneem Karim"
    },
    {
      "affiliations": [
        "Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Anna te Velde"
    },
    {
      "affiliations": [
        "Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Annabel Webb"
    },
    {
      "affiliations": [
        "Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Catherine Morgan"
    },
    {
      "affiliations": [
        "Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia",
        "Grace Centre for Newborn Care, Children’s Hospital at Westmead, Sydney, New South Wales, Australia"
      ],
      "name": "Nadia Badawi"
    },
    {
      "affiliations": [
        "Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Iona Novak"
    },
    {
      "affiliations": [
        "CSF Global, Dhaka, Bangladesh",
        "Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh"
      ],
      "name": "Saifuddin Ahmed"
    },
    {
      "affiliations": [
        "CSF Global, Dhaka, Bangladesh",
        "Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh"
      ],
      "name": "Shafiul Islam"
    },
    {
      "affiliations": [
        "CSF Global, Dhaka, Bangladesh"
      ],
      "name": "Iskander Hossain"
    },
    {
      "affiliations": [
        "Mymensingh Medical College Hospital, Mymensingh, Bangladesh"
      ],
      "name": "Nazrul Islam"
    },
    {
      "affiliations": [
        "CSF Global, Dhaka, Bangladesh",
        "Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh"
      ],
      "name": "Mohammad Muhit"
    },
    {
      "affiliations": [
        "School of Health, Medical and Applied Sciences, Rockhampton, Queensland, Australia",
        "Central Queensland University, Rockhampton, Queensland, Australia"
      ],
      "name": "Gulam Khandaker"
    }
  ],
  "title": "Early detection of cerebral palsy among a high-risk cohort in Bangladesh",
  "uid": "cf251800-a9f5-5b31-bee5-7bd5a40fc189"
}