Determinants of Abnormal Hammersmith Infant Neurological Examination Score in Very-Low-Birth-Weight Neonates

Ramsha Salimuddin, Shalini Tripathi, Mala Kumar, Shakal Narayan Singh

Abstract

Background: While neonatal care has improved the survival of premature neonates, neurodevelopmental delays may occur. The Hammersmith Infant Neurological Examination (HINE) is a simple, standardized neonatal examination that predicts abnormal neurological outcome over the long term.

Aim: To find the determinants of an abnormal HINE score in VLBW neonates at 6 months’ corrected age (CA)

Materials and Methods: This cohort study enrolled 139 hospitalized VLBW neonates. The neonates were followed up at 6 months’ CA to find the proportion of neonates with HINE score < 52. The determinants of abnormal HINE scores were also analyzed.

Results: Of the 139 VLBW neonates admitted, 70 (50.3%) were discharged, 51 (37%) died, and 18 (12.9%) left against medical advice. Their average gestational age (GA) was 30.9 weeks (SD = 3.06 wk), and birth weight was 1,175.46 g (SD = 233.85 g). Of the 70 discharged neonates, 51 (72.8%) were followed up at 6 months’ CA. Of the 51 neonates who were followed up, 15 (29.4%) had abnormal HINE scores. The mean HINE score was 59, ranging from 47 to 75. It was observed that GA (P = .005), need for mechanical ventilation for > 24 hours (P = .002), shock (P = .001), moderate-to-severe bronchopulmonary dysplasia (BPD; P = .009), necrotizing enterocolitis (NEC; P = .003), and grades 2 and 3 intraventricular hemorrhage (IVH; P = .001) were associated with abnormal HINE scores.

Conclusion: Overall, 29.4% of neonates had abnormal HINE scores, indicating future locomotor dysfunction. Low GA, mechanical ventilation, shock, moderate-to-severe BPD, NEC, and grades 2 and 3 IVH were associated with abnormal neurological outcome.