Early detection of neurodevelopmental delays and cerebral palsy (CP) in high-risk newborns is crucial, as timely intervention can significantly improve motor, cognitive, and social-emotional outcomes. However, in low- and middle-income countries (LMICs), access to advanced diagnostic tools such as MRI and specialised neurological care is often limited due to high costs, geographic barriers, and a shortage of trained professionals. Addressing these challenges, a study conducted at the Paediatric Neurology Unit, Teaching Hospital Karapitiya (THK), Sri Lanka, introduced a low-cost and effective method for early detection of developmental delays and CP.

The study utilised a modified protocol combining two General Movement Assessments (GMAs) and the Hammersmith Infant Neurological Examination (HINE), tailored to the resource limitations of LMICs. The protocol included three key assessments: Writhing Movements Assessment before hospital discharge (prior to 44 weeks of gestation), Fidgety Movements Assessment at 3–4 months corrected age, and HINE at 5–6 months corrected age. The study followed 201 high-risk infants and collected key data on birth histories, risk factors such as prematurity, low birth weight, birth asphyxia, and perinatal infections, along with cerebral palsy diagnoses and developmental assessments using the Bayley Scales of Infant Development (Bayley-4).

By the age of two, 10% of the children were diagnosed with CP, with spastic quadriplegia being the most prevalent subtype (50% of CP cases). Most of these children exhibited severe motor disabilities, a pattern that differs from high-income countries, likely due to differences in risk factors and access to early interventions. The Fidgety Movements Assessment at 3–4 months corrected age demonstrated over 95% sensitivity and specificity for CP, confirming its diagnostic value in LMIC settings and aligning with findings from high-income countries.

When the two GMAs and HINE assessments were combined, the predictive results were remarkable, achieving 100% sensitivity for CP detection with no missed cases. Additionally, the protocol demonstrated strong predictive accuracy for other developmental delays in the non-cerebral palsy group, with motor sensitivity exceeding 86.9%, cognitive sensitivity over 86.7%, and social-emotional sensitivity above 83.3%. This highlights the protocol’s ability to identify children at risk for developmental delays beyond CP, making it a valuable tool in LMIC healthcare systems.

This study underscores how innovative adaptations can overcome resource limitations. Unlike high-income countries, where neuroimaging is routinely used for early CP detection, this modified method relies on simple, cost-effective, and scalable tools. The findings emphasise several key points: high sensitivity without reliance on advanced imaging, the enhanced predictive accuracy of combining multiple assessments, the protocol’s seamless integration into routine care, and the acceptable rate of overidentification, which ensures access to early developmental therapies for children who may benefit from intervention.

This Sri Lankan study presents a transformative model for LMICs, demonstrating that early detection is not a luxury but a feasible reality. By integrating GMAs and HINE into routine checkups, healthcare systems can achieve early detection and intervention for high-risk infants. The broader implication is a paradigm shift in early intervention strategies globally, highlighting that healthcare innovation is not solely dependent on cutting-edge technology but also on optimising existing resources to make a tangible impact on children’s lives. This cost-effective approach offers hope to countless children and families, setting an example for other LMICs facing similar challenges in early neurodevelopmental care.