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Published on: August 25, 2014
Hammersmith Infant Neurological Examination and long-term cognitive outcome in children born very preterm
Karoliina Uusitalo1,2, Leena Haataja3, Anna Nyman4
1Department of Pediatric Neurology, University of Turku, Turku, Finland.
Insights
The Hammersmith Infant Neurological Examination (HINE) at age 2 predicts long-term neurocognitive outcomes in very preterm children. A higher HINE score indicates better general intelligence and neurological function at age 11.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Neurodevelopmental outcomes
Background:
- Very preterm birth is associated with an increased risk of neurodevelopmental impairments.
- Early neurological assessment is crucial for identifying children at risk.
- The Hammersmith Infant Neurological Examination (HINE) is a tool used to assess neurological status in infants.
Purpose of the Study:
- To investigate the association between the Hammersmith Infant Neurological Examination (HINE) at 2 years of corrected age and neurocognitive outcomes at 11 years in children born very preterm.
- To determine if HINE scores can predict neurological, motor, and cognitive development at school age.
Main Methods:
- A prospective cohort study included 174 children born very preterm (gestational age < 32 weeks).
- The Hammersmith Infant Neurological Examination (HINE) was administered at 2 years corrected age.
- Neurocognitive function at 11 years was assessed using the Touwen neurological examination, Movement Assessment Battery for Children (MABC-2), and Wechsler Intelligence Scale for Children (WISC-IV).
Main Results:
- The HINE global score at 2 years was significantly associated with neurological examination results (p=0.001), MABC-2 scores (p<0.001), and full-scale IQ (p<0.001) at 11 years.
- These associations remained significant even after adjustment for covariates.
- Even when excluding children with cerebral palsy, the HINE score still predicted full-scale IQ (p=0.01).
Conclusions:
- A higher Hammersmith Infant Neurological Examination (HINE) global score at 2 years is associated with better general intelligence and neurological function at 11 years in very preterm children.
- The HINE is a valuable tool for identifying very preterm infants at risk for later cognitive and neurological impairments.
- Early neurological assessment using the HINE can inform targeted interventions and support for neurodevelopmental outcomes.
Aim:
To study the association between the Hammersmith Infant Neurological Examination (HINE) at age 2 years and neurocognition at age 11 years in children born very preterm. We hypothesized that the HINE at 2 years would be associated with neurocognition, that is, neurological, motor, and cognitive outcomes at 11 years.
Method:
A total of 174 children (mean gestational age 29.0wks, SD 2.7; minimum 23.0, maximum 35.9; 95 [55%] males, 79 [45%] females) born very preterm (birthweight ≤1500g/gestational age <32wks), were included in a prospective cohort recruited from 2001 to 2006 in Turku, Finland. The HINE was performed at 2 years' corrected age. Neurocognition at 11 years was assessed with the Touwen neurological examination, Movement Assessment Battery for Children, Second Edition (MABC-2), and full-scale IQ (Wechsler Intelligence Scale for Children, Fourth Edition).
Results:
The HINE global score was associated with the results of the Touwen neurological examination (odds ratio [OR]=0.9, 95% confidence interval [CI] 0.8-0.9, p=0.001), MABC-2 (β=1.4, 95% CI 0.7-2.2, p<0.001), and full-scale IQ (β=1.2, 95% CI 0.8-1.7, p<0.001), even when adjusted. When children with cerebral palsy (CP) were excluded, the HINE was still associated with full-scale IQ (unadjusted β=1.2, 95% CI 0.3-2.1, p=0.01).
Interpretation:
A higher HINE global score at 2 years was associated with better general intelligence at 11 years even in children without CP. The HINE may be a useful tool to detect children at risk for later cognitive impairment. What this paper adds A Hammersmith Infant Neurological Examination (HINE) global score at 2 years was associated with long-term neurocognitive function. Severe cognitive impairment was significantly more common in 11-year-old children with complex minor neurological dysfunction compared to typically developing children. The HINE performed at 2 years detects risks of cognitive impairment at 11 years in children born very preterm. A higher HINE score at 2 years was associated with better general intelligence at 11 years.
