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Neurological assessment tool for screening infants during the first year after birth: The Brief-Hammersmith Infant
Domenico M Romeo1,2, Chiara Velli1, Francesca Sini1
1Paediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Insights
A new short version of the Hammersmith Infant Neurological Examination (HINE), called Brief-HINE, effectively screens for cerebral palsy (CP) in infants. This tool demonstrates good accuracy and predictive power for early detection of CP.
Area of Science:
- Pediatric neurology
- Developmental pediatrics
- Clinical assessment tools
Background:
- The Hammersmith Infant Neurological Examination (HINE) is a comprehensive tool for assessing infant neurological development.
- A shorter, more accessible screening tool is needed for routine clinical practice to identify infants at risk of cerebral palsy (CP).
Purpose of the Study:
- To develop a brief version of the HINE (Brief-HINE) for infant screening.
- To evaluate the accuracy and predictive power of the Brief-HINE for detecting cerebral palsy (CP).
Main Methods:
- Eleven key items from the original HINE, identified as predictive of CP, were selected.
- The Brief-HINE was applied to existing data from infants assessed at 3, 6, 9, and 12 months of age.
- Data included infants with typical development and those who later developed CP.
Main Results:
- The Brief-HINE demonstrated good sensitivity and specificity in detecting CP across all assessed ages.
- Specific cut-off scores at 3, 6, 9, and 12 months showed high accuracy (e.g., sensitivity of 0.88-1.00, specificity of 0.81-0.92).
- The presence of multiple warning signs on the Brief-HINE indicates a need for full HINE reassessment.
Conclusions:
- The Brief-HINE is a valid and reliable screening method for infants.
- Findings support the use of the Brief-HINE in routine clinical practice for early CP detection.
Aim:
To develop a short version of the original Hammersmith Infant Neurological Examination (HINE) to be used as a screening tool (Brief-HINE) and to establish if the short examination maintains good accuracy and predictive power for detecting infants with cerebral palsy (CP).
Method:
Eleven items were selected from the original HINE ('visual response'; 'trunk posture'; 'movement quantity'; 'movement quality'; 'scarf sign'; 'hip adductor angles'; 'popliteal angle'; 'pull to sit'; 'lateral tilting'; 'forward parachute reaction'; 'tendon reflexes') identifying those items previously found to be more predictive of CP in both low- and high-risk infants. In order to establish the sensitivity of the new module, the selected items were applied to existing data, previously obtained using the full HINE at 3, 6, 9, and 12 months, in 228 infants with typical development at 2 years and in 82 infants who developed CP.
Results:
Brief-HINE scores showed good sensitivity and specificity, at each age of assessment, for detecting infants with CP. At 3 months, a score of less than 22 was associated with CP with a sensitivity of 0.88 and a specificity of 0.92; at 6, 9, and 12 months, the cut-off scores were less than 25 (sensitivity 0.93; specificity 0.87), less than 27 (sensitivity 0.95; specificity 0.81), and less than 27 (sensitivity 1; specificity 0.86) respectively. The presence of more than one warning sign, or items that are not optimal for the age of assessment, imply the need for a full examination reassessment.
Interpretation:
These findings support the validity of the Brief-HINE as a routine screening method and the possibility of its use in clinical practice.
