Neonatal neurological examination as a predictor of neuromotor outcome at 4 months in term low-Apgar-score babies in Zimbabwe

The predictive value of the neonatal neurological examination (NNE) adapted from Prechtl, was investigated in 139 term Zimbabwean infants born with an Apgar score of five or less at 5 min. At 4 months, seven infants had died and 13 were lost to follow-up, leaving 119 infants to undergo the Infant Motor Screen (IMS). Eighty-eight infants were diagnosed as normal, six as suspect and 25 as abnormal at screening. The sensitivity, specificity, positive predictive value and negative predictive value of the NNE were 94%, 55%, 42% and 96%, respectively. Seventeen (14%) infants had developed microcephaly at 4 months and 13 (77%) of them scored abnormal on the IMS. Twenty-three of the 48 (48%) infants who had convulsions within 48 h of birth, were diagnosed as abnormal (P < 0.0001). The NNE proved to be very sensitive in detecting neurodevelopmental abnormalities in the neonatal period and the five abnormal syndromes derived from the NNE were able to correctly identify 94% of the abnormal infants. The incidence of birth asphyxia in term infants in developed countries is 2.9-9.0/1000 live births, and significantly higher in developing countries. Birth asphyxia is responsible for an estimated 3-21% of cases of cerebral palsy in both developed and developing countries. In developed countries, it has been demonstrated that abnormal findings in neonatal neurodevelopmental abnormalities are able to predict developmental disabilities in asphyxiated term infants. Findings are presented from a study conducted in Bulawayo, Zimbabwe, to explore the relationships between the neonatal neurological examination (NNE) adapted from Prechtl and neurological outcome at 4 months in babies with birth asphyxia. The NNE's predictive value was investigated in 139 term Zimbabwean infants born with an Apgar score of 5 or less at 5 minutes. At 4 months, 7 infants had died and 13 were lost to follow-up, leaving 119 infants to undergo the Infant Motor Screen (IMS). 88 infants were diagnosed as normal, 6 as suspect, and 25 as abnormal at screening. The sensitivity, specificity, positive predictive value, and negative predictive value of the NNE were 94%, 55%, 42%, and 96%, respectively. 17 infants had developed microcephaly at 4 months and 13 scored abnormal on the IMS. 23 of the 48 infants who had convulsions within 48 hours of birth were diagnosed as abnormal. The NNE was therefore highly sensitive in detecting neurodevelopmental abnormalities during the neonatal period and the 5 abnormal syndromes derived from the NNE were able to correctly identify 94% of the abnormal infants