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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Reliability of Neurobehavioral Assessments from Birth to Term Equivalent Age in Preterm and Term Born Infants
Abbey L Eeles1, Joy E Olsen1, Jennifer M Walsh1
1a Victorian Infant Brain Study , Murdoch Childrens Research Institute , RCH, Parkville , Victoria , Australia.
Insights
The Hammersmith Neonatal Neurological Examination (HNNE) and NICU Network Neurobehavioral Scale (NNNS) show excellent interrater reliability for assessing preterm infants before and at term-equivalent age.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Clinical assessment
Background:
- Neurobehavioral assessments are crucial for evaluating infant brain development and guiding early interventions.
- Assessing preterm infants before term-equivalent age is necessary due to shorter hospital stays.
- Limited data exists on the interrater reliability of common neurobehavioral assessments in preterm infants.
Purpose of the Study:
- To determine the interrater reliability of the Hammersmith Neonatal Neurological Examination (HNNE) and the NICU Network Neurobehavioral Scale (NNNS).
- To assess reliability when these tools are used in preterm infants and at term-equivalent age.
Main Methods:
- Thirty-five preterm infants and 11 term controls were evaluated.
- Five assessors independently administered the HNNE and NNNS.
- Interrater reliability was quantified using intraclass correlation coefficients (ICCs).
Main Results:
- The HNNE demonstrated excellent reliability for optimality scores (ICC > 0.74) and good to excellent for subtotal scores.
- The NNNS showed predominantly excellent interrater reliability across all items.
- High interrater agreement was observed for both assessments at both preterm and term time points.
Conclusions:
- Both the HNNE and NNNS exhibit strong interrater reliability for assessing preterm infants.
- These findings support the use of HNNE and NNNS in clinical settings for preterm infant neurobehavioral evaluation.
- Reliable assessments are vital for timely intervention and improved outcomes in preterm infants.
Abstract:
Neurobehavioral assessments provide insight into the functional integrity of the developing brain and help guide early intervention for preterm (<37 weeks' gestation) infants. In the context of shorter hospital stays, clinicians often need to assess preterm infants prior to term equivalent age. Few neurobehavioral assessments used in the preterm period have established interrater reliability.
Aim:
To evaluate the interrater reliability of the Hammersmith Neonatal Neurological Examination (HNNE) and the NICU Network Neurobehavioral Scale (NNNS), when used both preterm and at term (>36 weeks).
Methods:
Thirty-five preterm infants and 11 term controls were recruited. Five assessors double-scored the HNNE and NNNS administered either preterm or at term. A one-way random effects, absolute, single-measures interclass correlation coefficient (ICC) was calculated to determine interrater reliability.
Results:
Interrater reliability for the HNNE was excellent (ICC > 0.74) for optimality scores, and good (ICC 0.60-0.74) to excellent for subtotal scores, except for 'Tone Patterns' (ICC 0.54). On the NNNS, interrater reliability was predominantly excellent for all items. Interrater agreement was generally excellent at both time points.
Conclusions:
Overall, the HNNE and NNNS neurobehavioral assessments demonstrated mostly excellent interrater reliability when used prior to term and at term.
