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Updated: Mar 24, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurobehaviour and neurological development in the first month after birth for infants born between 32-42 weeks'
Alicia J Spittle1, Jennifer Walsh2, Joy E Olsen3
1Physiotherapy Department, University of Melbourne, 7th Floor Alan Gilbert Building, Grattan Street, Parkville, Victoria 3052, Australia; Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia; Newborn Research, The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia.
Insights
This study establishes reference values for newborn neurobehavioral assessments in moderate preterm (MPT), late preterm (LPT), and full-term (FT) infants. Full-term infants generally showed better performance across the Hammersmith Neonatal Neurological Examination (HNNE), Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS), and General Movements Assessment (GMA).
Area of Science:
- Neonatal Neurology
- Developmental Pediatrics
- Neurodevelopmental Assessment
Background:
- Establishing normative data for neurobehavioral assessments is crucial for identifying developmental trajectories in infants.
- Preterm birth, including moderate preterm (MPT) and late preterm (LPT) categories, can influence neurodevelopmental outcomes compared to full-term (FT) infants.
Purpose of the Study:
- To generate reference values for three key newborn neurobehavioral examinations in infants born moderate preterm (MPT), late preterm (LPT), and full term (FT).
- To assess performance on the Hammersmith Neonatal Neurological Examination (HNNE), Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS), and Prechtl's General Movements Assessment (GMA).
- To determine the influence of sex, gestational age at birth, and postmenstrual age on these assessments within different gestational age groups.
Main Methods:
- A prospective cohort study design was employed.
- Recruited 80 MPT, 129 LPT, and 201 FT infants from a tertiary hospital shortly after birth.
- Administered HNNE, NNNS, and GMA within the first weeks after birth.
Main Results:
- Reference values (means, standard deviations, centiles) were generated for HNNE and NNNS across MPT, LPT, and FT groups.
- Full-term infants demonstrated superior performance compared to MPT and LPT infants on the HNNE and NNNS.
- Normal General Movements Assessment (GMA) rates were 25% for MPT, 32% for LPT, and 90% for FT infants in the early weeks post-birth.
Conclusions:
- This study provides essential normative data for the HNNE, NNNS, and GMA in MPT, LPT, and FT infants.
- These reference values aid in the interpretation of neurobehavioral assessments in the early postnatal period.
- Understanding these benchmarks is vital for tracking neurodevelopmental progress and identifying potential concerns in preterm and term infants.
Aims:
The objective of this study was to generate reference values for infants born moderate preterm (MPT), late preterm (LPT) and full term (FT) for three newborn neurobehavioural/neurological examinations in the first weeks after birth.
Study Design:
Prospective cohort study to examine the expected range of values for MPT (born 32(+0) to 33(+6)), LPT (34(+0) to 36(+6)) and FT (born 37 to 42weeks' gestation) infants' performance on the Hammersmith Neonatal Neurological Examination (HNNE), the Neonatal Intensive Care Unit Network Neurobehavioural Scale (NNNS) and Prechtl's General Movements Assessment (GMA) in the first weeks after birth. Further, to determine the effects of sex, gestational age at birth, and postmenstrual age at assessment on the 3 different assessments within the gestational age groups.
Subjects:
80 MPT, 129 LPT and 201 FT infants were recruited shortly after birth from a tertiary hospital.
Results:
The means, standard deviations and 5th, 10th, 25th, 50th, 75th, 90th and 95th centiles are presented for the HNNE and NNNS for each of the three gestational age groups. Overall, FT infants performed better than MPT and LPT infants. The rate of normal GMA within the first few weeks after birth was 25% for MPT, 32% for LPT, and 90% for FT infants. The effects of sex, gestational age at birth, and postmenstrual age at assessment varied between test and gestational age groups.
Conclusions:
This study provides normative data for the HNNE, NNNS, and GMA administered within the first weeks after birth in a sample of MPT, LPT and healthy FT infants.
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