Abstract
Background
The Hammersmith Infant Neurological Examination is one of several useful tools for
early identification of cerebral palsy; however, cut-off scores for cerebral palsy
do not consistently distinguish infants with hemiplegia from those typically developing.
We hypothesized that use of an asymmetry score, in addition to the assessment's standard
total cutoff score, could remedy this problem in a clinical setting.
Methods
This retrospective study of a neonatal intensive care follow-up program with consistent
clinical use of the Hammersmith Infant Neurological Examination matched infants with
a diagnosis of cerebral palsy to infants without motor delays or evidence of neurodevelopmental
impairments. Groups had same corrected and gestational ages at Hammersmith Infant
Neurological Examination assessment. Asymmetry presence was recorded.
Results
Of 74 infants with cerebral palsy, 28 had quadriplegia, 11 had diplegia, and 35 had
hemiplegia. Median total Hammersmith Infant Neurological Examination and asymmetry
scores for hemiplegia were 57.5 and 10 versus 76 and 0 for those without cerebral
palsy. Sensitivity and specificity to distinguish hemiplegia from typical development
by combining a total Hammersmith Infant Neurological Examination score less than 63
and an asymmetry score greater than 5 were 91.8% and 100%, respectively.
Conclusions
In a clinical setting, combining total Hammersmith Infant Neurological Examination
and asymmetry scores can help providers differentiate infants with hemiplegia from
those typically developing.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Pediatric NeurologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Optimality score for the neurologic examination of the infant at 12 and 18 months of age.J Pediatr. 1999; 135: 153-161https://doi.org/10.1016/s0022-3476(99)70016-8
- Use of Hammersmith Infant Neurological examination in infants with cerebral palsy: a critical review of the literature.Dev Med Child Neurol. 2015; 58: 240-245https://doi.org/10.1111/dmcn.12876
- Early neurologic assessment in preterm-infants: integration of traditional neurologic examination and observation of general movements.Eur J Paediatr Neurol. 2008; 12: 183-189https://doi.org/10.1016/j.ejpn.2007.07.008
- Implementation of early diagnosis and intervention guidelines for cerebral palsy in a high-risk infant follow-up clinic.Pediatr Neurol. 2017; 76: 66-71https://doi.org/10.1016/j.pediatrneurol.2017.08.002
- Implementation of the Hammersmith Infant Neurological Examination in a high-risk infant follow-up program.Pediatr Neurol. 2016; 65: 31-38https://doi.org/10.1016/j.pediatrneurol.2016.09.010
- A report: the definition and classification of cerebral palsy April 2006.Dev Med Child Neurol. 2007; 49: 8-14https://doi.org/10.1111/j.1469-8749.2007.tb12610.x
- Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment.JAMA Pediatr. 2017; 171: 879-907https://doi.org/10.1001/jamapediatrics.2017.1689
- Development and reliability of a system to classify gross motor function in children with cerebral palsy.Dev Med Child Neurol. 1997; 39: 214-223https://doi.org/10.1111/j.1469-8749.1997.tb07414.x
- Mini‐MACS: development of the Manual Ability Classification System for children younger than 4 years of age with signs of cerebral palsy.Dev Med Child Neurol. 2017; 59: 72-78https://doi.org/10.1111/dmcn.13162
- Cranial ultrasound lesions in the NICU predict cerebral palsy at age 2 years in children born at extremely low gestational age.J Child Neurol. 2009; 24: 63-72https://doi.org/10.1177/0883073808321048
- Early prediction of cerebral palsy after neonatal intensive care using motor development trajectories in infancy.Early Hum Dev. 2013; 89: 781-786https://doi.org/10.1016/j.earlhumdev.2013.06.004
- Development of the Hand Assessment for Infants: evidence of internal scale validity.Dev Med Child Neurol. 2017; 59: 1276-1283https://doi.org/10.1111/dmcn.13585
- An algorithm for identifying and classifying cerebral palsy in young children.J Pediatr. 2008; 153: 466-472https://doi.org/10.1016/j.jpeds.2008.04.013
Article info
Publication history
Published online: July 25, 2018
Accepted:
July 8,
2018
Received:
May 22,
2018
Footnotes
This work was supported by 1R01HD081120-01A1 from the NICHD to NL Maitre. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Declaration of Conflicting Interests: Authors declare no potential conflicts of interest.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
