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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Infant neurological examination from 3 to 12 months: predictive value of the single items
A Pizzardi1, D M M Romeo, M Cioni
1Division of Child Neurology and Psychiatry, Department of Paediatrics, University of Catania, Catania, Italy.
Insights
The Hammersmith Infant Neurologic Examination (HINE) effectively predicts cerebral palsy in infants. Key indicators include movement quality and quantity, with specific items like tone, reflexes, and reactions varying in predictive value by age.
Area of Science:
- Developmental Pediatrics
- Neurology
- Clinical Diagnostics
Background:
- Early detection of neurological impairments is crucial for timely intervention.
- The Hammersmith Infant Neurologic Examination (HINE) is a standardized tool for assessing infant neurological development.
- Understanding the prognostic value of individual HINE items can refine early diagnostic capabilities.
Purpose of the Study:
- To longitudinally evaluate the prognostic value of individual items within the HINE.
- To identify specific HINE components that best predict cerebral palsy at 2 years of age.
- To determine age-specific predictive patterns of HINE items in infants.
Main Methods:
- Longitudinal study of 658 infants assessed at 3, 6, 9, and 12 months post-term.
- Utilized Receiver Operating Characteristic (ROC) curves to analyze prediction of cerebral palsy at 2 years.
- Assessed global HINE scores and individual item performance.
Main Results:
- Global HINE scores demonstrated high predictive accuracy for cerebral palsy across all assessed ages (ROC areas > 0.9).
- Movement quality and quantity consistently showed the highest predictive value.
- Predictive item importance varied by age: tone assessment was key in the first six months, while reflexes and reactions became more predictive later.
Conclusions:
- The HINE is a powerful tool for predicting cerebral palsy in the first year of life.
- Its predictive strength relies on a combination of different items that change in importance with infant age.
- Clinical practice should consider age-specific item profiles when interpreting individual neurological assessments using the HINE.
Abstract:
The prognostic value of the single items of a standardised neurological examination, the Hammersmith Infant Neurologic Examination (HINE), was explored longitudinally in 658 infants at 3, 6, 9 and 12 months post-term age. ROC curves were built based on the presence/absence of cerebral palsy at 2 years of age. Global HINE scores showed very high prediction (ROC curve areas above 0.9) at all ages. The items with the highest predictive value were always movement quality and quantity. In the first semester, among the most predictive items were those assessing tone, while beyond that time they were reflexes and reactions. Our results show that the high predictive value of the HINE across the first year of life is granted by the successful combination of different groups of items for each age-period. This should be recognised in clinical practice when assessing the significance of individual neurological profiles.
