Publications relating to the Neonatal Exam (HNNE)
Dubowitz L, Mercuri E, Dubowitz V. An optimality score for the neurologic examination of the term newborn. J Pediatr 1998 Sep;133(3):406-16.
This paper describes how the original examination was updated and how it was applied to 224 healthy term newborn infants. It also explains the concept of optimality score and how this was obtained.
Mercuri E, Guzzetta A, Haataja L, Cowan F, Rutherford M, Counsell S, Papadimitriou M, Cioni G, Dubowitz L. Neonatal neurological examination in infants with hypoxic ischaemic encephalopathy: correlation with MRI findings. Neuropediatrics. 1999 Apr;30(2):83-9.
This paper examines the correlation between abnormal findings on the HNNE and different patterns of brain injury on neonatal MRI in a cohort of full term infants with hypoxic-ischaemic encephalopathy (HIE). The predictive value of the HNNE in infants with HIE was also tested.
McGready R, Simpson J, Panyavudhikrai S, Loo S, Mercuri E, Haataja L, Kolatat T, Nosten F, Dubowitz L. Neonatal neurological testing in resource-poor settings. Ann Trop Paediatr. 2000 Dec;20(4):323-36.
This article describes the development and testing of a shortened version of the HNNE to be used by paramedical staff in a low-resource setting.
Mercuri E, Guzzetta A, Laroche S, Ricci D, Vanhaastert I, Simpson A, Luciano R, Bleakley C, Frisone MF, Haataja L, Tortorolo G, Guzzetta F, de Vries L, Cowan F, Dubowitz L. Neurologic examination of preterm infants at term age: comparison with term infants. J Pediatr. 2003 Jun;142(6):647-55.
The neonatal neurological examination was performed at term age in 157 low-risk preterm infants born between 25 and 34 weeks’ gestation who had cranial ultrasound scans that were normal or showed minor abnormalities. The distribution of scores was obtained and is shown in this article. These results are explained in the Hammersmith Neonatal Neurological examination video and in the supporting scoring information. The distribution of scores is included in one of the HNNE proformas.
Guzzetta A, Haataja L, Cowan F, Bassi L, Ricci D, Cioni G, Dubowitz L, Mercuri E. Neurological examination in healthy term infants aged 3-10 weeks. Biol Neonate. 2005;87(3):187-96.
A group of healthy full-term infants was examined with the HNNE in the first 48 hours after birth and then again between 3 and 10 weeks of age. The paper describes how scores changed with time, and the definite shift in their distribution observed around 6 weeks of age.
Romeo DM, Ricci D, Brogna C, Cilauro S, Lombardo ME, Romeo MG, Mercuri E. Neurological examination of late-preterm infants at term age. Eur J Paediatr Neurol. 2011 Jul;15(4):353-60.
This article describes the range and frequency distribution of neonatal neurological scores in a cohort of 375 low risk late-preterm infants (34-36 weeks gestation) assessed at 39-41 weeks postmenstrual age. These results can be used as reference data when examining late-preterm infants at term age.
Romeo DM, Ricci D, van Haastert IC, de Vries LS, Haataja L, Brogna C, Gallini F, Romagnoli C, Cowan FM, Mercuri E. Neurologic assessment tool for screening preterm infants at term age. J Pediatr. 2012 Dec;161(6):1166-8.
This article presents a short version of the HNNE that can be used as a screening tool in low-risk preterm infants at term equivalent age. The proforma of this short version is available for downloading in the Recording and scoring Proformas section.
Romeo DM, Luciano R, Corsello M, Ricci D, Brogna C, Zuppa A, Romagnoli C, Mercuri E. Neonatal neurological examination of late preterm babies. Early Hum Dev. 2013 Aug;89(8):537-45.
This article describes the range and frequency distribution of neonatal neurological scores in a cohort of 118 low-risk preterm infants (34-36 weeks) who were assessed between 48 and 72 hours after birth. These results can be used as reference data when examining late-preterm infants in the first 72 postnatal hours.
Hagmann CF, Chan D, Robertson NJ, Acolet D, Nyombi N, Nakakeeto M, Cowan FM. Neonatal neurological examination in well newborn term Ugandan infants. Early Hum Dev. 2015 Dec;91(12):739-49.
This study examined a cohort of low-risk term newborn Ugandan infants with the HNNE and compared the raw and optimality scores to published data from UK infants. The analysis showed that Ugandan infants had significantly stronger palmar grasp, better auditory and visual orientation, less irritability and less need for consoling but poorer tone, poorer quality of spontaneous movements and more abnormal signs than UK infants. Significantly fewer Ugandan infantshad optimal scores based on the UK data. This study
Spittle AJ, Walsh J, Olsen JE, McInnes E, Eeles AL, Brown NC, Anderson PJ, Doyle LW, Cheong JLY. Neurobehaviour and neurological development in the first month after birth for infants born between 32-42 weeks’ gestation. Early Hum Dev. 2016 May;96:7-14.
This study provides normative data (means, standard deviations and 5th, 10th, 25th, 50th, 75th, 90th and 95th centiles) for the HNNE, the Neonatal Intensive Care Unit Network Neurobehavioural Scale (NNNS) and Prechtl’s General Movements Assessment, which were administered within the first weeks after birth in a sample of 80 moderate preterm infants (32-33+6 weeks), 129 late preterm infants (34-36+6 weeks) and 201 healthy full term infants.
Eeles AL, Olsen JE, Walsh JM, McInnes EK, Molesworth CM, Cheong JL, Doyle LW, Spittle AJ. Reliability of Neurobehavioral Assessments from Birth to Term Equivalent Age in Preterm and Term Born Infants. Physical & Occupational Therapy In Pediatrics, 2017;37:1, 108-119.
This study assessed the interrater reliability of the Hammersmith Neonatal Neurological Examination (HNNE) and the NICU Network Neurobehavioral Scale (NNNS), when used both preterm and at term age in a group of 35 preterm infants and 11 term infants. The analyses showed that interrater reliability for the HNNE was excellent (ICC > 0.74) for optimality scores, and good (ICC 0.60–0.74) to excellent for subtotal scores, except for ‘Tone Patterns’ (ICC 0.54).
Romeo DM, Bompard S, Cocca C, Serrao F, De Carolis MP, Zuppa AA, Ricci D, Gallini F, Maddaloni C, Romagnoli C, Mercuri E. Neonatal neurological examination during the first 6h after birth. Early Hum Dev. 2017;108:41-44.
A cohort of 124 low risk term born newborns was examined with the HNNE within 3 h from birth or between 3 and 6 h. Each infant was re-assessed at 48 hours, and the range and frequency distribution of neonatal neurological scores at each time point were recorded and compared. The results showed that for 23/34 of the neurological items, the range and median scores were similar across the 3 time points. In the remaining 11 items the three groups had a similar range of scores but the median scores were different with different rates of changes. In 6 of the 11 the median scores at 3-6h were similar to those observed at 48h but they appeared to be ‘less mature’ at 0-3h. Only in one item the median scores were consistently different at the 3 time points. This study provides information on the very early neurological assessment of term newborn infants and shows that a complete neurological examination can already be reliably performed soon after birth.
George JM, Fiori S, Fripp J, Pannek K, Guzzetta A, David M, Ware RS, Rose SE, Colditz PB, Boyd RN. Relationship between very early brain structure and neuromotor, neurological and neurobehavioral function in infants born <31 weeks gestational age. Early Hum Dev. 2018 Feb;117:74-82.
A large cohort of preterm infants underwent early and term-equivalent-age MRI as well as several neurological clinical assessments: General Movements Assessment, Hammersmith Neonatal Neurological Examination (HNNE), NICU Neonatal Neurobehavioral Scale (NNNS), the Premie-Neuro, the Test of Infant Motor Performance (TIMP) and a visual assessment. The analysis showed that brain structures on early and term MRI were associated with concurrent motor, neurological and neurobehavioral function.