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

Objectives: To evaluate whether a structured and scorable neurologic examin ation (The Hammersmith Infant Neurological Examination) correlates with ear ly magnetic resonance imaging findings in a group of infants with hypoxic-i schemic encephalopathy (HIE) and whether the scores of this assessment can predict the locomotor function in these children. Study design: A total of 53 term infants fulfilling the criteria for HIE un derwent scanning within 4 weeks from delivery with a 1 Tesla HPQ magnet. Th e scores from the neurologic examination performed between 9 to 14 months w ere correlated to the neonatal magnetic resonance imaging findings and to t he maximal locomotor function defined at the ages of 2 and 4 years. Results: The scores were always optimal in the infants with normal or minor neonatal magnetic resonance imaging findings. The lowest scores were assoc iated with severe basal ganglia and white matter lesions. hll the infants w ho had a global score between 67 and 78 at 1 year were able to walk indepen dently at 2 years and without restrictions at 4 years. Scores between 40 an d 67 were associated with restricted mobility and scores <40 with severely limited self-mobility at 2 and 4 years. Conclusions: The use of a standardized neurologic optimality scoring system gives additional prognostic information, easily available in the clinic, o n the severity of the functional motor outcome in infants with HIE.