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 examination (The Hammersmith Infant Neurological Examination) correlates with early magnetic resonance imaging findings in a group of infants with hypoxic-ischemic 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 underwent scanning within 4 weeks from delivery with a 1 Tesla HPQ magnet. The scores from the neurologic examination performed between 9 to 14 months were correlated to the neonatal magnetic resonance imaging findings and to the 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 associated with severe basal ganglia and white matter lesions. 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.
CONCLUSIONS: The use of a standardized neurologic optimality scoring system gives additional prognostic information, easily available in the clinic, on the severity of the functional motor outcome in infants with HIE.