Disability Prediction by Early Hammersmith Neonatal Neurological Examination: A Diagnostic Study

Abstract

Background and Objectives: Hammersmith Neonatal Neurologic Examination (HNNE) is used to identify term and preterm infants at risk of neurodevelopmental disability. The test is recommended at corrected term age in preterm; and around 2 weeks postnatal age in term neonates. As the current trend is to discharge based on physiological stability, it may not be feasible to perform HNNE at recommended age. The authors investigated whether predictive ability of the test for neurodevelopmental disability remained unchanged if performed early (before discharge). Methods: The authors enrolled preterm and at-risk term neonates. HNNE PE was performed before discharge in all infants. The test was repeated in preterm infants at 40 weeks postmenstrual age and in term neonates at 2 weeks of age (HNNE RA). Neurodevelopmental disability was assessed at 1 year of age. Results: HNNE PE was done in 125 neonates (103 preterm, 22 term neonates). HNNE RA was done in 58% infants. Neurodevelopmental disability was assessed in 84 (67%) of infants. Neurodevelopmental disability was noted in 14/84 (16.6%) babies. The receiver operating characteristic curve of raw scores showed that area under the curve for HNNE PE (0.71) and HNNE RA (0.66) were similar. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for both the tests were similar for a cutoff optimality score of 32.5. HNNE PE could be performed up to 4 weeks earlier than HNNE RA with the same predictive ability for neurodevelopmental disability. Conclusions: HNNE PE was as reliable as HNNE RA in predicting neurodevelopmental disability at 1 year of age. Completion of the test is assured and provides several weeks lead time for early intervention.

Assessing the Utility of Neonatal Screening Assessments in Early Diagnosis of Cerebral Palsy in Preterm Infants

“…This is consistent with current evidence, which suggests that the HNNE performed at two weeks post-term in term infants, or at termcorrected age in preterm infants, is highly predictive of a neurodevelopmental deficit [28]. A recent study by Venkata et al found that the HNNE had an equivalent predictive value for predicting CP at 1 year when performed early (i.e., before discharge in preterm infants) and when performed at the recommended age as outlined above [28]. The HNNE had a sensitivity of 50-64% and specificity of 73-77% with a global optimality score cut-off of 32.5, as per Dubowitz [19,28].…”

“…However, this association was not statistically significant ( p = 0.05, 95% CI [0.78, 1.00]). This is consistent with current evidence, which suggests that the HNNE performed at two weeks post-term in term infants, or at term-corrected age in preterm infants, is highly predictive of a neurodevelopmental deficit [ 28 ]. A recent study by Venkata et al found that the HNNE had an equivalent predictive value for predicting CP at 1 year when performed early (i.e., before discharge in preterm infants) and when performed at the recommended age as outlined above [ 28 ].…”

Phase-Based Cortical Synchrony Is Affected by Prematurity

“…The HNNE was selected due to its wide use in assessment of neurological behavior in multiple populations ( Romeo et al. 2011 ; Venkata et al. 2020 ).…”

Early Diagnostics and Early Intervention in Neurodevelopmental Disorders—Age-Dependent Challenges and Opportunities

“…In moderate-to-late preterm infants HNNE scores were associated with an increased risk of cognitive delay at 2 years, but not with motor and language outcome [77]. In a mixed group of infants mostly comprising preterm infants, HNNE predicted adverse neurodevelopmental outcome at 1 year with sensitivities of 50%-64% and specificities of 73%-77% [79]. A study performed in the prehypothermia era in infants with HIE indicated that HNNE has good predictive properties [81].…”

“…It is also advised to perform HNNE in preterm infants at TEA. Yet, the study of Venkata et al [79] suggests that the predictive properties of HNNE performed around 36 weeks, that is, at an age that most preterm infants are still in the hospital, is similar to that of HNNE at TEA. The predictive values of HNNE in preterm infants vary.…”