Sage Journals: Discover world-class research

Abstract

Background and Objectives:

Hammersmith Neonatal Neurologic Examination (HNNE) is used to identify term and preterm infants at risk of neurodevelopmental disability. The test is recommended at corrected term age in preterm; and around 2 weeks postnatal age in term neonates. As the current trend is to discharge based on physiological stability, it may not be feasible to perform HNNE at recommended age. The authors investigated whether predictive ability of the test for neurodevelopmental disability remained unchanged if performed early (before discharge).

Methods:

The authors enrolled preterm and at-risk term neonates. HNNE PE was performed before discharge in all infants. The test was repeated in preterm infants at 40 weeks postmenstrual age and in term neonates at 2 weeks of age (HNNE RA). Neurodevelopmental disability was assessed at 1 year of age.

Results:

HNNE PE was done in 125 neonates (103 preterm, 22 term neonates). HNNE RA was done in 58% infants. Neurodevelopmental disability was assessed in 84 (67%) of infants. Neurodevelopmental disability was noted in 14/84 (16.6%) babies. The receiver operating characteristic curve of raw scores showed that area under the curve for HNNE PE (0.71) and HNNE RA (0.66) were similar. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for both the tests were similar for a cutoff optimality score of 32.5. HNNE PE could be performed up to 4 weeks earlier than HNNE RA with the same predictive ability for neurodevelopmental disability.

Conclusions:

HNNE PE was as reliable as HNNE RA in predicting neurodevelopmental disability at 1 year of age. Completion of the test is assured and provides several weeks lead time for early intervention.

Keywords

at-risk neonates Hammersmith Neonatal Neurological Examination neurodevelopmental disability

Get full access to this article

View all access options for this article.

References

George

Boyd

Colditz

, et al. PPREMO: a prospective cohort study of preterm infant brain structure and function to predict neurodevelopmental outcome. BMC Pediatr. 2015;15(1):123. http://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-015-0439-z.

Dubowitz

Ricciw

Mercuri

. The Dubowitz neurological examination of the full-term newborn. Ment Retard Dev Disabil Res Rev. 2005;11(1):52–60.

Dubowitz

Mercuri

Dubowitz

. An optimality score for the neurologic examination of the term newborn. J Pediatr. 1998;133(3):406–416.

Spittle

Walsh

Potter

, et al. Neurobehaviour at term-equivalent age and neurodevelopmental outcomes at 2 years in infants born moderate-to-late preterm. Dev Med Child Neurol. 2017;59(2):207–215.

Setänen

Lehtonen

Parkkola

Aho

Haataja

, the PIPARI Study Group. Prediction of neuromotor outcome in infants born preterm at 11 years of age using volumetric neonatal magnetic resonance imaging and neurological examinations. Dev Med Child Neurol. 2016;58(7):721–727.

Sujatha

Jain

. Prediction of neurodevelopmental outcome of preterm babies using risk stratification score. Indian J Pediatr. 2016;83(7):640–644.

Hardy

Good

Dobson

Palmer

Tung

Phelps

, Early Treatment for Retinopathy of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity. Results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol. 2003;121(12):1684.

Patni

. Developmental Assessment Scales for Indian Infants (DASII). Ind J Pr Pediatr. 2012;14:409–412.

Prechtl

HF.

The Neurological Examination of the Full-Term Newborn Infant: A Manual for Clinical Use from the Department of Developmental Neurology. Vol. 63. Cambridge: Cambridge University Press; 1991.

10.

Gosselin

Gahagan

Amiel-Tison

. The Amiel-Tison neurological assessment at term: conceptual and methodological continuity in the course of follow-up. Ment Retard Dev Disabil Res Rev. 2005;11(1):34–51.

11.

Einspieler

Prechtl

. Prechtl’s assessment of general movements: a diagnostic tool for the functional assessment of the young nervous system. Ment Retard Dev Disabil Res Rev. 2005;11(1):61–67.

12.

Prechtl

Einspieler

Cioni

Bos

Ferrari

Sontheimer

. An early marker for neurological deficits after perinatal brain lesions. Lancet. 1997;349(9062):1361–1363.

13.

Spittle

Brown

Doyle

, et al. Quality of general movements is related to white matter pathology in very preterm infants. Pediatrics. 2008;121(5):e1184–1189.

14.

Amess

McFerran

Khan

Rabe

. Early prediction of neurological outcome by term neurological examination and cranial ultrasound in very preterm infants. Acta Paediatr. 2009;98(3):448–453.

15.

Dubowitz

Mercuri

. The Neurological Assessment of the Preterm and Full-Term Newborn Infant. Cambridge: Cambridge University Press; 1999.

16.

Soni

Kadam

Pandit

Patole

. Early discharge of preterm infants—an Indian perspective. J Clin Diagn Res. 2016;10(12):SC21.

17.

Jefferies

Society

Fetus, Committee

. Going home: facilitating discharge of the preterm infant. Paediatr Child Health. 2014;19(1):31–36.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.18 MB

Disability Prediction by Early Hammersmith Neonatal Neurological Examination: A Diagnostic Study

Abstract

Background and Objectives:

Methods:

Results:

Conclusions:

Keywords

Get full access to this article

References

Supplementary Material