HAMMERSMITH NEONATAL NEUROLOGICAL EXAMINATION OF HEALTHY TERM INFANTS AT AGES 6 AND 10 WEEKS IN TSHWANE DISTRICT, SOUTH AFRICA

M. Nel^1,2,3, U. Feucht^1,2,4, H. Mulol^1,2,4, C. Eksteen³

¹Research Centre for Maternal, Foetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa, ²Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Unit, Pretoria, South Africa, ³Sefako Makgatho Health Sciences University, Physiotherapy, Ga-Rankuwa, South Africa, ⁴University of Pretoria, Paediatrics, Pretoria, South Africa

Background: The neurodevelopmental progress of infants below three months is globally not well described. Important changes occur in the maturation of the central nervous system of infants at 6 weeks that signify this age as an important milestone for monitoring neurodevelopmental progress. A lack of published data on normative values of child development in this age group has been identified globally. In South Africa (SA), neurodevelopmental characteristics of infants at well-baby 6- and 10-week visits are omitted from the ‘Road to Health Booklet’, a nationally used patient-held clinical record. The neurodevelopmental status of infants in these age groups is not routinely monitored and data is not documented.

Purpose: This study aimed firstly to assess and attribute raw scores (RSs) to the neuro-behavioural characteristics of healthy 6- and 10-week term-born infants in the Tshwane District in SA using the Hammersmith Neonatal Neurological Examination (HNNE). Secondly, we aimed to quantify the performance of the infants by applying the HNNE optimality scoring system to the RSs obtained during the examination. To our knowledge, no data of its kind in this age group has previously been documented.

Methods: A prospective longitudinal study was performed on a cohort of 35 healthy term-born infants from low-risk pregnancies at 6- and 10-weeks postnatal age in the Tshwane District, SA. The status of infants’ posture, tone, reflexes, movements, orientation and behaviour was recorded on the HNNE proforma evaluation form. Cut-off points on the 5th and 10th centiles, according to the HNNE optimality scoring system, were applied to the RSs of the 34 items in the proforma evaluation form.

Results: This study illustrated the frequency distribution of RSs for this cohort of infants for each item in the HNNE evaluation form. The results were quantified per 6- and 10- week post-natal age groups respectively using the HNNE optimality scoring system. The results of this study illustrate the direction of ongoing changes in upper and lower limb tone, active head control in horizontal and vertical positions, and advanced visual orientation and alertness in this cohort of infants towards 10 weeks.

Conclusions: The study quantitatively supports previous observations that mark 6 weeks as an important milestone for neurodevelopmental change in clinically healthy term-born infants. Further changes in milestone characteristics indicate that 10 weeks is another important milestone in the neurodevelopmental process.

Implications: This study presents the first results of ongoing research and evolving data for identifying a developmental trajectory of neuro-motor and neuro-behavioural characteristics of healthy term-born infants at 6- and 10 weeks in a developing country. Quantifying and grading the characteristics of neurodevelopmental responses at 6 and 10 weeks respectively will enable health care professionals to identify infants at risk of neurodevelopmental pathology or delay. Studying bigger cohorts in SA may result in the collection of data that can be generalised and then incorporated into the RtHB. Such data will lead to a greater understanding, continuous monitoring, and effective management of infants and as such contribute to achieving Child Health Sustainable Development Goals in SA.

Funding acknowledgements: The author(s) received no specific funding for this work.

Keywords:
Hammersmith Neonatal Neurological Examination
Neurodevelopment 6 and 10 weeks
Sustainable Developmental Goals

Topics:
Paediatrics
Neurology
Globalisation: health systems, policies & strategies

Did this work require ethics approval? Yes

Institution: University of Pretoria, South Africa

Committee: University of Pretoria Research Ethics Committee

Ethics number: Reference no. 283/2019