Neonatal neurological testing in resource-poor settings

The aim of the study was to design and test a neurological examination for newborns that could be performed reliably by paramedical staff in resource- poor settings. The examination was adapted from a method established by Dub owitz et al., the latest version of which includes an optimality score. The final items in the rest were chosen because they were culturally acceptabl e, could be elicited according to strict but easily comprehensible instruct ions and because the expected responses could be scored by the descriptions given or by diagrams in the proforma. The shortened examination was easily taught to paramedical staff who achieved a high degree of inter-observer r eliability. This shortened version of the examination was piloted by compar ing newborns from a Karen refugee camp on the western border of Thailand an d from a large maternity hospital in Bangkok with a standardized cohort of newborns in London. The modified shortened version of the test was sufficie ntly sensitive to identify a number of differences between the cohorts, not ably the poor vision performance and markedly reduced tone of the Karen new borns. In conclusion, the test can be used very reliably by paramedical sta ff and is a useful, simple and portable tool for the neurological assessmen t of newborn babies where resources are limited.