Early neurologic assessment in pre-term infants: integration of traditional neurologic examination and observation of general movements

Objective: To evaluate the possible additional benefit in terms of prognostic accuracy ofan integrated application of a traditional scorable method of neurologic examination andthe Prechtl’s method of qualitative assessment of general movements (GMs) in a largepopulation of 903 consecutive preterm infants.Study design: Infants were enrolled from the Intensive Care Unit of the University ofCatania. Inclusion criteria were a gestational age below 37 weeks and the absence ofgenetic disorders. All infants underwent serial ultrasound and at 3 months performed boththe GMs assessment and the Hammersmith Infant Neurologic Examination (HINE).Outcome was assessed at 2 years by the Touwen neurologic examination and the ClinicalAdaptive Test/Clinical, Linguistic and Auditory Milestone Scale.Results: The integration of the two methods was shown to be more effective than thesingle assessments in predicting neurologic outcome. The additional benefit of combiningthe two approaches was particularly clear for the discrimination between unilateral andbilateral cerebral palsy.Conclusions: The integrated use of a scorable neurological examination and Prechtl’sassessment of GMs can improve early prediction of neurodevelopmental outcome inpreterm infants and should complement other clinical and instrumental exams in followupprograms.