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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

  • Leena Haataja
    Affiliations
    Department of Paediatrics, Hammersmith Hospital and Robert Steiner MRI Unit, Imperial College, London, United Kingdom; Stella Maris Scientific Institute, Department of Reproduction and Developmental Medicine, University of Pisa, Pisa, Italy; the Division of Child Neurology, Catholic University, Rome, Italy; and the Department of Paediatric Neurology, Turku University Central Hospital, Turku, Finland
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  • Eugenio Mercuri
    Affiliations
    Department of Paediatrics, Hammersmith Hospital and Robert Steiner MRI Unit, Imperial College, London, United Kingdom; Stella Maris Scientific Institute, Department of Reproduction and Developmental Medicine, University of Pisa, Pisa, Italy; the Division of Child Neurology, Catholic University, Rome, Italy; and the Department of Paediatric Neurology, Turku University Central Hospital, Turku, Finland
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  • Andrea Guzzetta
    Affiliations
    Department of Paediatrics, Hammersmith Hospital and Robert Steiner MRI Unit, Imperial College, London, United Kingdom; Stella Maris Scientific Institute, Department of Reproduction and Developmental Medicine, University of Pisa, Pisa, Italy; the Division of Child Neurology, Catholic University, Rome, Italy; and the Department of Paediatric Neurology, Turku University Central Hospital, Turku, Finland
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  • Mary Rutherford
    Affiliations
    Department of Paediatrics, Hammersmith Hospital and Robert Steiner MRI Unit, Imperial College, London, United Kingdom; Stella Maris Scientific Institute, Department of Reproduction and Developmental Medicine, University of Pisa, Pisa, Italy; the Division of Child Neurology, Catholic University, Rome, Italy; and the Department of Paediatric Neurology, Turku University Central Hospital, Turku, Finland
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  • Serena Counsell
    Affiliations
    Department of Paediatrics, Hammersmith Hospital and Robert Steiner MRI Unit, Imperial College, London, United Kingdom; Stella Maris Scientific Institute, Department of Reproduction and Developmental Medicine, University of Pisa, Pisa, Italy; the Division of Child Neurology, Catholic University, Rome, Italy; and the Department of Paediatric Neurology, Turku University Central Hospital, Turku, Finland
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  • Maria Flavia Frisone
    Affiliations
    Department of Paediatrics, Hammersmith Hospital and Robert Steiner MRI Unit, Imperial College, London, United Kingdom; Stella Maris Scientific Institute, Department of Reproduction and Developmental Medicine, University of Pisa, Pisa, Italy; the Division of Child Neurology, Catholic University, Rome, Italy; and the Department of Paediatric Neurology, Turku University Central Hospital, Turku, Finland
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  • Giovanni Cioni
    Affiliations
    Department of Paediatrics, Hammersmith Hospital and Robert Steiner MRI Unit, Imperial College, London, United Kingdom; Stella Maris Scientific Institute, Department of Reproduction and Developmental Medicine, University of Pisa, Pisa, Italy; the Division of Child Neurology, Catholic University, Rome, Italy; and the Department of Paediatric Neurology, Turku University Central Hospital, Turku, Finland
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  • Frances Cowan
    Affiliations
    Department of Paediatrics, Hammersmith Hospital and Robert Steiner MRI Unit, Imperial College, London, United Kingdom; Stella Maris Scientific Institute, Department of Reproduction and Developmental Medicine, University of Pisa, Pisa, Italy; the Division of Child Neurology, Catholic University, Rome, Italy; and the Department of Paediatric Neurology, Turku University Central Hospital, Turku, Finland
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  • Lilly Dubowitz
    Affiliations
    Department of Paediatrics, Hammersmith Hospital and Robert Steiner MRI Unit, Imperial College, London, United Kingdom; Stella Maris Scientific Institute, Department of Reproduction and Developmental Medicine, University of Pisa, Pisa, Italy; the Division of Child Neurology, Catholic University, Rome, Italy; and the Department of Paediatric Neurology, Turku University Central Hospital, Turku, Finland
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      Abstract

      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. (J Pediatr 2001;138:332-7)

      Abbreviations:

      HIE (Hypoxic-ischemic encephalopathy), MRI (Magnetic resonance imaging), PLIC (Posterior limb of the internal capsule)
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