Telehealth Hammersmith Infant Neurological Examination and early diagnosis of cerebral palsy

AIM: To compare the performance characteristics of telehealth versus in-person Hammersmith Infant Neurological Examination (HINE) assessment to support early diagnosis of cerebral palsy (CP). METHOD: This study is a retrospective secondary analysis of prospectively collected HINE data from a neonatal intensive care follow-up clinic, comparing telehealth versus in-person HINE at 3, 6, 9, and 12 months between patients with CP versus patients without CP. RESULTS: Of 650 included children, 244 (38%) had at least one telehealth HINE and 148 (23%) were diagnosed with CP with median age at last follow-up of 24 months. HINE score was associated with CP at 3, 6, 9, and 12 months for both telehealth and in-person exams (telehealth odds ratio 0.74-0.90 [95% confidence interval 0.56-0.97], p = 0.01 to <0.001; sensitivity 50%-100% and specificity 69%-93%, in-person odds ratio 0.74-0.86 [95% confidence interval 0.78-0.89], p < 0.001; sensitivity 69%-83% and specificity 88%-97%). There was no significant difference in area under the receiver operating curve between in-person and telehealth evaluations at any age. INTERPRETATION: Telehealth and in-person HINE evaluation across the first year of life were both effective for supporting early CP diagnosis. Extending HINE testing to telehealth provides an opportunity to increase early diagnosis of CP in settings with limited resources and long geographic distances to specialty newborn intensive care unit follow-up clinics.