Optimality score for the neurologic examination of the infant at 12 and 18 months of age,☆☆,

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Abstract

The aim of this study was to develop and validate a simple, quantifiable, neurologic examination for infants between 2 and 24 months of age. The assessment consists of 37 items, divided into 3 sections. The first section includes 26 items assessing cranial nerve function, posture, movements, tone, and reflexes; the second section of 8 items documents the development of motor function, and the third section of 3 items evaluates the state of behavior. We applied this assessment to a cohort of ninety-two 12-month-old infants and forty-three 18-month-old infants, with no known perinatal risk factors. The proforma presented has been designed according to the frequency distribution of the neurologic findings in this cohort. Each item is scored individually, and a global score is the sum of all individual scores. The quantitative score enhances the value of this examination, both in clinical practice and in research settings. (J Pediatr 1999;135:153-61)

Section snippets

SUBJECTS AND METHODS

The infants in this study were part of a cohort of 249 infants born at Queen Charlotte and Chelsea Hospital, regarded as normal after birth, who were admitted with their mothers to the postnatal ward; their mothers consented to an assessment during the first 2 days after delivery.3 Details of perinatal data and neonatal neurologic investigation were available for all. The project was approved by the Research Ethical Committee of the Royal Postgraduate Medical School.

When the children in this

Clinical Examination

The details of the results are shown in Figs 1 to 5 (Appendix).

DISCUSSION

Since the pioneering work of Saint-Anne Dargassies,8 who developed an examination based on the evaluation of active and passive tone, there have been a number of methods used for the neurologic examination of the infant after the neonatal period.8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 Probably the most widely used are those described by Amiel-Tison et al16, 19 and Touwen,8 both providing useful information on the maturation of tone, reflexes, and reactions. Although both authors gave very

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From the Department of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom.

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Reprint requests: Lilly Dubowitz, MD, FRCPCH, Department of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Rd, London W12 ONN, United Kingdom.

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