Implementation of guidelines for early detection of cerebral palsy. A single-site study in Spain

Abstract

The 2017 international guidelines for early detection of cerebral palsy (CP) provide a framework for identifying and managing infants at risk. Yet their implementation in clinical practice remains limited in some settings and countries. This study aimed to implement these guidelines in a Spanish tertiary hospital and assess their impact on the timing of CP diagnosis and referral to early intervention. A pre/post observational design was used, structured around a three-phase implementation strategy: (1) planning and preparation, (2) installation, and (3) early implementation of systematic screening of infants with “high-risk” markers. We compared a historical baseline cohort (born 2017–2021, n = 18 children diagnosed with CP) and an implementation cohort (born 2022–2023, n = 57 enrolled, n = 4 children diagnosed with CP). Among infants with CP in the implementation cohort, referral to early intervention occurred at a mean corrected age of 1.9 months, “high-risk” of CP designation at 3.7 months, and CP diagnosis at 9.2 months. In the baseline period, mean age at diagnosis was 17.4 months, yielding a mean reduction of 8.2 months during implementation (95 % CI: −13.8 to −2.6, p < 0.05). Twelve key recommendations were partially (50 %) or consistently (20 %) applied. Findings support the feasibility of implementing the guidelines and suggest improved identification and surveillance outcomes, including earlier diagnosis. Structured implementation pathways are needed to integrate these practices into routine care and promote equitable access across health systems.