Partnering Early to Provide for Infants At Risk of Cerebral Palsy (PEPI ARC): protocol for a feasibility study of a regional hub for early detection of cerebral palsy in Aotearoa New Zealand.

Introduction: Cerebral palsy (CP) can now be diagnosed in infants with identified CP risk factors as early as three months of age; however, many barriers prevent equitable access to early detection pathways. The "Partnering Early to Provide for Infants At Risk of Cerebral Palsy" feasibility study (PEPI ARC) seeks to trial a new approach to decrease inequitable health service in Aotearoa New Zealand for high-risk infants and their families. PEPI ARC incorporates face-to-face clinics, an in-person and virtual Hub, and the use of telehealth to enable flexible access to CP assessments and support for health professionals in early CP detection. Methods and analysis: A non-randomised feasibility study was conducted from a tertiary Neonatal Intensive Care Unit (NICU) in Wellington and included seven regional referral centres, servicing nearly 30% of the total population in New Zealand (NZ). The families of infants with a high risk of neurodevelopmental impairment and health professionals interacting with the Hub were invited to participate. Mixed methods were used to evaluate the (i) equitable implementation of an early detection pathway, (ii) acceptability, (iii) demand among families and health professionals, (iv) efficacy in relation to reducing the age of receipt of CP diagnosis, and (v) the experiences around communication and information sharing. Ethics and dissemination: The NZ Health and Disability Ethics Committee approved this study (HDEC: 2022 FULL 13434). The findings will be disseminated in peer-reviewed journals, in conference presentations, and via professional networks. Clinical trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12623000600640.

Early identification of infants at risk of cerebral palsy: developing the use of general movement assessment in routine clinical practice in a tertiary neonatal unit in New Zealand.

BACKGROUND: Preterm infants have a high risk of neurodevelopmental disability, including cerebral palsy (CP). Often, CP is not diagnosed until after 12 months, leading to delay in targeted interventions. The General Movements assessment (GM) evaluates the spontaneous movements of high-risk infants from birth to 20 weeks corrected postnatal age (CPA), and accurately predicts the risk of CP. This allows for earlier diagnosis and intervention, potentially changing the trajectory of disability, yet routine use of GM is not well established in New Zealand. AIM: To describe the process of setting up GM in a tertiary neonatal unit. METHODS: We reviewed the process and progress made to date setting up GM in our service. RESULTS: Challenges and potential solutions for the implementation of GM were identified. Key areas of development included staff training and support, IT services, resources, medical documentation, inter-departmental communication and establishing clinical pathways. CONCLUSION: GM has become successfully integrated into the assessment of high-risk infants in our neonatal unit, with the aim to provide valuable information to health professionals and families to optimise intervention and improve outcomes. Efforts will continue to ensure there is robust and sustainable system for using GM in our service.