Neurological assessment at five years of age in infants born preterm

Abstract

Aim: To evaluate the agreement between Touwen's neurological examination and a derived simplified one, created to be applied at the age of 5 y to infants born preterm. Methods: 185 children born at a gestational age (GA) of <33 wk and/or with a birthweight <1501 g, free of cerebral palsy, underwent Touwen's neurological examination at a mean age of 5 y and 8 mo (5‐6.5 y). One‐hundred and seventy had a full examination and were included into the study. They were born at a mean GA of 30 wk (range 24–35 wk) with a mean birthweight of 1250 g (range 600–2690 g). A simplified examination, based on the clinical experience of two of the authors, was created a priori. The data were reviewed retrospectively and the concordance between the two forms was assessed. The reviewers were blinded to the original categorization from the long form. Results: On the basis of the original Touwen's neurological examination, the 170 children were classified into 122 with a normal neurological examination, 41 with grade 1 minor neurological dysfunction (MND) and 7 with grade 2 MND, giving 28% of the cohort with MND. The concordance between the two forms was excellent, with an agreement in 169 out of 170 subjects. None of the infants with the most complex form of MND was misclassified. Conclusion: The simplicity of this examination could allow its diffusion and its use in follow‐up programmes. It could improve the quality of routinely collected follow‐up data of preterm neonates.

Minor neurological dysfunction and associations with motor function, general cognitive abilities, and behaviour in children born extremely preterm

“…However, the study by Fily et al, 17 , showed good agreement between the two approaches; we are therefore confident that neither prevalence of MND in our sample nor associations with other neurodevelopmental domains were significantly affected by using the simplified version. We showed that in children born extremely preterm the prevalence of MND was significantly higher than in term-born participants, and that this has clinically significant implications for everyday motor function, cognitive abilities, and behaviour.…”

“…Neurological profile was assessed with a simplified version of the Touwen Infant Neurological Examination 17 and included the evaluation of four domains: reflexes, nerve function of the face and eyes, posture and muscle tone, and coordination and balance. The findings were classified on the basis of the number of dysfunctional domains, as normal neurology, simple MND (one or two domains abnormal), or complex MND (more than two domains abnormal).…”

“…The findings were classified on the basis of the number of dysfunctional domains, as normal neurology, simple MND (one or two domains abnormal), or complex MND (more than two domains abnormal). 17 CP was diagnosed on the basis of the criteria of the Surveillance of Cerebral Palsy in Europe Working Group. 18 The Movement Assessment Battery for Children, Second Edition (MABC-2) 19 was used to assess motor function.…”

Morning Glory Disc Anomaly in childhood – a population‐based study

“…N indicated normal clusters, MND‐1 one or two dysfunctional clusters and MND‐2 more than two dysfunctional clusters (Fily et al. ). An adapted version of this test was used, adding posture during walking, biceps reflex and muscle tone in the elbows (Table ).…”

“…A shortened version with 16 selected items grouped into clusters was used with classifications based on the number of dysfunctional clusters. N indicated normal clusters, MND-1 one or two dysfunctional clusters and MND-2 more than two dysfunctional clusters (Fily et al 2003). An adapted version of this test was used, adding posture during walking, biceps reflex and muscle tone in the elbows ( Table 2).…”