Articles relating to the Infant Exam (HINE)

Haataja L, Mercuri E, Regev R, Cowan F, Rutherford M, Dubowitz V, Dubowitz L. Optimality score for the neurologic examination of the infant at 12 and 18 months of age. J Pediatr 1999;135:153-61.

This paper describes how the optimality score for the HINE at 12 and 18 months was developed in a cohort of 92 12-month-old infants and 43 18-month-old infants with no perinatal risk factors. 

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Haataja L, Mercuri E, Guzzetta A, Rutherford M, Counsell S, Flavia Frisone M, Cioni G, Cowan F, Dubowitz L. Neurologic examination in infants with hypoxic-ischemic encephalopathy at age 9 to 14 months: use of optimality scores and correlation with magnetic resonance imaging findings. J Pediatr. 2001 Mar;138(3):332-7.

Fifty-three term infants with hypoxic-ischaemic encephalopathy had a brain MRI scan performed within the first 4 postnatal weeks and were examined using the HINE between 9 and 14 months. The scores from the HINE were related with the MRI findings and with outcome at 2 and 4 years. All the infants who had a global score between 67 and 78 at 1 year were able to walk independently at 2 years and without restrictions at 4 years. Scores between 40 and 67 were associated with restricted mobility and scores <40 with severely limited self-mobility at 2 and 4 years.  The scores were always optimal in the infants with normal or minor neonatal lesions on the neonatal MRI, whereas the lowest scores were associated with severe basal ganglia and white matter lesions.  

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Frisone MF, Mercuri E, Laroche S, Foglia C, Maalouf EF, Haataja L, Cowan F, Dubowitz L. Prognostic value of the neurologic optimality score at 9 and 18 months in preterm infants born before 31 weeks’ gestation. J Pediatr. 2002 Jan;140(1):57-60.

Seventy-four preterm infants (24-30.5 weeks at birth) were examined using the HINE between 9 and 18 months’ chronological age (6-15 months’ corrected age). The scores from the HINE were used to predict locomotor outcomes at 2 years. 

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Haataja L, Cowan F, Mercuri E, Bassi L, Guzzetta A, Dubowitz L. Application of a scorable neurologic examination in healthy term infants aged 3 to 8 months. J Ped 2003; 143:546.

This brief communication describes the optimality scores of 74 healthy term infants assessed between 12 and 32 weeks of age, and it is a complement of the 1999 paper by Haataja L et al (see above). 

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Ricci D, Cowan F, Pane M, Gallini F, Haataja L, Luciano R, Cesarini L, Leone D, Donvito V, Baranello G, Rutherford M, Romagnoli C, Dubowitz L, Mercuri E. Neurological examination at 6 to 9 months in infants with cystic periventricular leukomalacia. Neuropediatrics. 2006 Aug;37(4):247-52.

The HINE was performed in 24 infants (26-38 weeks at birth) with cystic periventricular leukomalacia when they were between 6 and 9.5 months corrected age. The pattern of findings on neurological examination was described, and the scores were correlated with motor impairment at 2 years. Optimality scores between 41 and 60 were generally associated with sitting but not walking at 2 years whilst scores below 40 were always associated with the inability to sit independently at 2 years. All infants who did not develop cerebral palsy at 2 years had scores > 60.

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Ricci D, Guzzetta A, Cowan F, Haataja L, Rutherford M, Dubowitz L, Mercuri E. Sequential neurological examinations in infants with neonatal encephalopathy and low apgar scores: relationship with brain MRI. Neuropediatrics. 2006 Jun;37(3):148-53.

In this study 15 children with low Apgar scores, neonatal encephalopathy and abnormal outcome  were examined at 1 – 2 weeks, 5 – 7 weeks, and 6 months. The pattern of neurological abnormalities was related with the pattern of brain injury on the neonatal brain MRI.  

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Romeo DM, Cioni M, Scoto M, Mazzone L, Palermo F, Romeo MG. Neuromotor development in infants with cerebral palsy investigated by the Hammersmith Infant Neurological. Examination during the first year of age. EJPN 2008; 12: 24–31.

In this study a cohort of 70 infants with a diagnosis of cerebral palsy (CP) at 2 years of age was evaluated by the HINE at 3, 6, 9 and 12 months of corrected age and the scores were correlated with the severity of CP at 2 years (measured using the Gross Motor Function Classification System – GMFCS). There was a strong ( r=−0.82) and significant ( p<0.0001) negative correlation between the scores of the HINE and the levels of GMFCS. Using the HINE before 12 months it was possible to predict the type (quadriplegia, diplegia, hemiplegia) and severity of CP. 

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Romeo DM, Guzzetta A, Scoto M, Cioni M, Patusi P, Mazzone D, Romeo MG. Early neurologic assessment in preterm-infants: integration of traditional neurologic examination and observation of general movements. EJPN 2008;12:183-189.

In this study 903 preterm infants were examined at three months using the HINE and the Prechtl’s method of qualitative assessment of general movements (GMs). Infants were assessed again at 2 years with the Touwen neurological examination and the Clinical Adaptive Test/Clinical, Linguistic and Auditory Milestone Scale. The combination of both methods was found to be more predictive than each one separately. 

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Karagianni P, Tsakalidis C, Kyriakidou M, Mitsiakos G, Chatziioanidis H, Porpodi M, Evangeliou A, Nikolaides N. Neuromotor outcomes in infants with bronchopulmonary dysplasia. Pediatr Neurol. 2011;44:40-6.

The HINE was used in a cohort of 219 preterm infants (<32 weeks) at 6 and 12 months. Of them, 38 (17.3%)
had mild bronchopulmonary dysplasia (BPD), 11 (5.0%) had moderate BPD, and 12 (5.4%) had severe BPD. Infants with severe BPD had lower score in the HINE at 6 and 12 months corrected age, although only at 6 months the effect of the BPD was statistically independent of other perinatal risk factors. At 12 months corrected age, periventricular leukomalacia and hospital stay were the only factors with an independent negative impact on total scores on the HINE.  

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Romeo DM, Brogna C, Sini F, Romeo MG, Cota F, Ricci D. Early psychomotor development of low-risk preterm infants: Influence of gestational age and gender. EJPN 2016;20:e518-523.

This article shows the typical scores on the HINE of a cohort of preterm infants of different gestational ages at 3, 6, 9 and 12 months corrected age, and how the compare with the scores of a group of term born infants. 

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Maitre NL, Chorna O, Romeo DM, Guzzetta A. Implementation of the Hammersmith Infant Neurological Examination in a High-Risk Infant Follow-Up Program. Pediatr Neurol. 2016;65:31-38.

This article describes the training and implementation process of the HINE in an High-Risk Infant Follow-Up program: the challenges encountered, the solutions found, and the educational tools used.   

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Chatziioannidis I, Kyriakidou M, Exadaktylou S, Antoniou E, Zafeiriou D, Nikolaidis N. Neurological outcome at 6 and 12 months corrected age in hospitalised late preterm infants -a prospective study. Eur J Paediatr Neurol. 2018 Jul;22(4):602-609.

This study examined a cohort of 157 late preterm infants (born between 34 and 36+6 weeks gestation) who had been admitted to NICU after birth. The HINE at 6 and 12 months corrected age showed higher incidence of suboptimal scores (>84%) compared to infants born at term and late low-risk preterm infants. The scores increased over time from 6 to 12 months. In this cohort, being born small for gestational age was the only factor adversely related to outcome.

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