Burton Vera Joanna, Kannan Sujatha, Jayakumar Srishti, Gerner Gwendolyn, West Salome, Yenokyan Gayane, Duncan Andrea F
Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD 21205, USA.
Division of Neurology and Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, MD 21224, USA.
J Clin Med. 2025 Feb 26;14(5):1572. doi: 10.3390/jcm14051572.
: The Hammersmith Infant Neurological Examination (HINE) is a standardized neurologic exam for infants between 2 and 24 months. Scores can be compared to optimality cutoffs as one component to support an early diagnosis of cerebral palsy (CP). Some prognosis is also possible for infants diagnosed with CP. We aimed to understand the longitudinal trajectories of HINE scores in infants who were ultimately diagnosed with CP. : Clinical records were reviewed for children who were diagnosed with CP in two high-risk infant follow-up clinics with HINE scores from at least two visits between the corrected ages of 3 months and 2 years. Trajectories were calculated individually and by group for infants in four categories-term neonatal hypoxic ischemic encephalopathy (HIE), term perinatal arterial ischemic stroke (PAIS), premature infants with brain injury, and "Other" (term infants with congenital malformations and/or congenital hydrocephalus). The changes in HINE scores between clinic visits were compared using linear mixed-effect models with a random intercept, pulling data by diagnostic group across visits and accounting for within-child correlations of scores over the follow-up time. : The changes in HINE scores for sixty children (twenty-five with prematurity, eighteen with HIE, seven with PAIS, and ten in the other category) were assessed. The linear mixed-effect models indicated that the infants with PAIS had an estimated 10.8-point increase in total HINE scores after 9 months of age compared to earlier assessments (95% CI [2.5, 19.2]. There was no statistically significant improvement in the scores among the infants in the other brain injury groups. The infants with PAIS had an estimated 2.9-point increase in HINE asymmetry scores after 9 months of age compared to prior visits (95% CI [0.7, 5.1]). None of the other diagnostic categories had statistically significant increases in asymmetry scores over time. : The children with PAIS with resultant hemiplegia showed increasing HINE scores throughout the first two years of life. In contrast, the HINE scores remained stable for those children with term HIE, prematurity-associated brain injury, and congenital malformations and/or congenital hydrocephalus diagnosed with CP. Tracking individual changes (or stability) in HINE scores can aid diagnosis, inform prognosis, and guide the design of clinical trials targeting neurologic injury.
哈默史密斯婴儿神经学检查(HINE)是一项针对2至24个月婴儿的标准化神经学检查。分数可与最佳临界值进行比较,作为支持早期诊断脑瘫(CP)的一个组成部分。对于被诊断为CP的婴儿,也可以进行一些预后评估。我们旨在了解最终被诊断为CP的婴儿的HINE分数的纵向轨迹。:回顾了两家高危婴儿随访诊所中被诊断为CP的儿童的临床记录,这些儿童在矫正年龄3个月至2岁之间至少有两次就诊的HINE分数。分别计算了四类婴儿(足月儿新生儿缺氧缺血性脑病(HIE)、足月儿围产期动脉缺血性卒中(PAIS)、脑损伤早产儿和“其他”(患有先天性畸形和/或先天性脑积水的足月儿))的个体轨迹和分组轨迹。使用具有随机截距的线性混合效应模型比较就诊之间HINE分数的变化,按诊断组提取各次就诊的数据,并考虑随访期间儿童分数的内部相关性。:评估了60名儿童(25名早产儿、18名HIE患儿、7名PAIS患儿和10名其他类型患儿)的HINE分数变化。线性混合效应模型表明,与早期评估相比,PAIS患儿在9个月龄后总HINE分数估计增加10.8分(95%可信区间[2.5,19.2])。其他脑损伤组婴儿的分数没有统计学上的显著改善。与之前就诊相比,PAIS患儿在9个月龄后HINE不对称分数估计增加2.9分(95%可信区间[0.7,5.1])。随着时间的推移,其他诊断类别中不对称分数均无统计学上的显著增加。:患有PAIS并导致偏瘫的儿童在生命的头两年中HINE分数不断增加。相比之下,那些被诊断为CP的足月HIE患儿、早产相关脑损伤患儿以及先天性畸形和/或先天性脑积水患儿的HINE分数保持稳定。追踪HINE分数的个体变化(或稳定性)有助于诊断、提供预后信息并指导针对神经损伤的临床试验设计。