Examining and counselling the family of a high-risk infant — OSCE

OSCE communication and shared decision-making station: examining a four-month-old infant born preterm in the neonatal follow-up clinic, explaining to the family what the increased tone and the absent fidgety movements mean, what the General Movements Assessment and Hammersmith Infant Neurological Examination are for, why an early magnetic resonance imaging and a referral are being arranged, and what the trajectory and the safety-net are — while addressing fear, guilt, and the question of whether something was missed.

osce communication and shared decision-making3 min readVerification in progress

Prompt

A four-month-old infant, born at 30 weeks gestation and seen at corrected age in the neonatal follow-up clinic, sits with both parents. The parents have noticed the baby is stiff down the right side and feeds slowly. Your examination shows a soft flat fontanelle, a head circumference tracking along the 50th centile, an alert and socially engaged infant, increased tone with a velocity-dependent catch in the right arm and leg, a fisted right hand, brisk right-sided reflexes, an extensor right plantar response, and absent fidgety movements on General Movements Assessment. The parents are frightened, feel guilty about the premature birth, and have read online about cerebral palsy. Examine the infant and counsel them.

Task

Examine the infant and then counsel the parents. You have eight minutes — approximately three minutes for the focused examination and five for the communication. Demonstrate an organised, empathic and accurate explanation that addresses the four questions a fellowship communication station rewards: what the findings are and what they may mean, how you will confirm it, what the plan and the timeframe are, and what the family should watch for. The framework follows the international early-detection pathway for cerebral palsy. [8]

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References4Show ledger

[4]Prechtl HF, Einspieler C, Cioni G, et al. An early marker for neurological deficits after perinatal brain lesions Lancet, 1997.PMID 9149699
[6]Sanger TD, Delgado MR, Gaebler-Spira D, et al. Classification and definition of disorders causing hypertonia in childhood Pediatrics, 2003.PMID 12509602
[8]Novak I, Morgan C, Adde L, et al. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment JAMA Pediatr, 2017.PMID 28715518
[9]Morgan C, Fetters L, Adde L, et al. Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews JAMA Pediatr, 2021.PMID 33999106