Neurological assessment tool for screening infants during the first year after birth: The Brief-Hammersmith Infant Neurological Examination

Abstract

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.