Elsevier

The Journal of Pediatrics

Volume 133, Issue 3, September 1998, Pages 406-416
The Journal of Pediatrics

An optimality score for the neurologic examination of the term newborn,☆☆,

https://doi.org/10.1016/S0022-3476(98)70279-3Get rights and content

Abstract

We describe the application of a revised version of the Dubowitz neurologic examination of the newborn in 224 low-risk, term newborn infants. The method has been updated by eliminating less useful items and including new items evaluating general movements and patterns of distribution of tone. An optimality score is included to make the evaluation more quantitative and for comparison with sequential examinations with neurophysiologic and imaging findings. The score is based on the distribution of the scores for each item in the population of low-risk term infants. We defined not only the most common pattern for each item but also the variability of the findings by using 10th and 5th centiles. Because most of the items assessing tone and the Moro reflex varied with gestational age between 37 and 42 weeks, the changes were incorporated in the scoring system. The total optimality score was the sum of the optimality scores of individual items. Although the association of 4 or more deviant scores was found in less than 10% of our infants, deviant results on 1 or 2 single items could be observed in a third of this normal population, suggesting that isolated deviant signs have little diagnostic value. In contrast, an abnormal distribution of tone patterns, which we have commonly observed in infants with brain lesions, was not found in this cohort. (J Pediatr 1998;133:406-16)

Section snippets

Subjects and Methods

Mothers of infants admitted to the postnatal ward in the Queen Charlotte and Chelsea Hospital were asked to volunteer to have a neurologic examination and a cranial ultrasonographic scan performed on their infants. Examiners visited the hospital 2 or 3 days a week over a period of 6 months. On those days they tried to examine all the available term infants. The only inclusion criteria were that the children were regarded as normal and that their postnatal age was between 6 and 48 hours. Because

Results

Two hundred and fifty of 253 mothers who were asked to volunteer for the project agreed to the clinical neurologic examination. Twenty-six infants were excluded because their gestational age was below 37 weeks or because they had low Apgar scores or low cord pH. The gestational age of the infants included ranged between 37 and 42 weeks (mean age, 40.2 weeks). The characteristics of the population studied are listed in Table I.

. Characteristics of the cohort studied

ParityMaternal age (y)Mode of

Discussion

Although there have been considerable advances in the use of imaging and neurophysiologic techniques in newborns with neurologic problems over the last 2 decades, the neurologic examination still plays an important role in the assessment of the newborn. There is still the need for improvement in its sensitivity to detect clinical neurologic abnormalities.

On the basis of 15 years of experience with the Dubowitz neurologic examination, we realized that the method needed to be updated, eliminating

References (31)

  • P Casaer

    Postural behaviour in newborn infants

    Clinics in Developmental Medicine

    (1979)
  • C Amiel-Tison et al.

    Evaluation neurologique du nouveau-ne et du nourisson

    (1980)
  • LMS Dubowitz et al.

    The neurological assessment of the preterm and full-term newborn infant

    Clinics in Developmental Medicine

    (1981)
  • FD Eyler et al.

    Quantification of the Dubowitz neurological assessment of preterm neonates: developmental outcome

    Infant Behav Dev

    (1991)
  • LM Dubowitz et al.

    Developmental sequence of periventricular leukomalacia. Correlation of ultrasound, clinical and nuclear magnetic resonance imaging

    Arch Dis Child

    (1985)
  • Cited by (155)

    • Brain Injury in the Preterm Infant

      2023, Avery's Diseases of the Newborn
    • A Neurologist's Guide to Neonatal Neurodevelopmental Assessments and Preterm Brain Injury

      2022, Seminars in Pediatric Neurology
      Citation Excerpt :

      Optimality scores have subsequently been established to account for the variability in response. For certain items, absence of a response is normal whereas for other items a strong response is normal.86 These scores are based on the distribution of the raw scores for each item.

    View all citing articles on Scopus

    From the Department of Paediatrics and Neonatal Medicine, Royal Postgraduate Medical School, London, UK.

    ☆☆

    Reprint requests: Lilly Dubowitz, Department of Paediatrics, Hammersmith Hospital, Du Cane Rd, London W12 OHS, UK.

    0022-3476/98/$5.00 + 0  9/21/88989

    View full text