Early detection of infants with neurodevelopmental concerns indicative of cerebral palsy in a lower middle-income country (India).

AIM To determine reproducibility and diagnostic accuracy of screening tools for neuromotor concerns indicative of cerebral palsy (CP) at 18 months corrected age by using the General Movements Assessment (GMA) and/or Hammersmith Infant Neurological Examination (HINE) in West Bengal, India. METHOD This prospective substudy tested psychometrics of screening tools nested within an overarching randomized control trial. A total of 785 infants with birth/infant-detectable risk factors, aged 12 to 40 weeks corrected age (n = 422 male, mean corrected age 22.6 weeks, SD = 10.2), were recruited. Infants were screened for 'high-risk CP' using the GMA (absent/abnormal fidgety, 12-17 weeks corrected age) and/or HINE (3 months < 56, 6 months < 59, 9 months < 62, 18-40 weeks corrected age). 'Neuromotor concerns indicative of CP' were classified at 18 months corrected age by a physician from a videoed neurological examination and semi-structured movement protocol. We analysed the results (1) using Gwet's AC1 and (2) for sensitivity and specificity. RESULTS Interrater reproducibility was strong (Gwet's AC1 = 0.89, p < 0.001). A total of 165 out of 749 assessments were screened as 'high-risk CP' (22.0%; 95% confidence interval 19.2-25.1). The screening programme (GMA/HINE) was 80.1% accurate (GMA [only] sensitivity = 87.8%, specificity = 44.4%; HINE [only] sensitivity = 94.0%, specificity = 60.0%). INTERPRETATION The GMA and/or HINE are reliable and accurate tools for screening high-risk populations in India, and may be useful in other low- and middle-income countries to identify infants with neuromotor concerns indicative of CP who could be triaged to early intervention.