The use of a standardized clinical neuromotor examination performed at 3 months of age (NMS-3), as a predictor of 1-year outcome (NMS-12), is evaluated in a prospective study of 60 term infants with perinatal depression, at the University of California, San Francisco. The NMS-3 examination, scored from 0 to 5, correlated with the NMS-12 or 12-month neurologic examination. Neurologic abnormalities were present in 52% at 1 year; transient abnormalities occurred in a group of 18 infants. All infants with an NMS-3 score of 5 had an abnormal exam at 1 year. Neonatal seizures were predictive of an increased risk of developmental abnormalities at 1 year. [1]
COMMENT. A neurologic examination of high-risk term infants at 3 months of age will identify children likely to have neurologic abnormalities at 1 year and allow early intervention therapy. Transient neurologic abnormalities characterized by increased tone at 3 months may be associated with a 20% risk of mild neurodevelopmental delay at 12 months and cognitive impairment with school problems in later childhood. Neonatal asphyxia complicated by seizures is strongly correlated with neurologic abnormalities at 1 year.
Neonatal neurologic prognostication in the asphyxiated term newborn is reviewed by pediatric neurologists at the Montreal Children’s Hospital [2]. These authors emphasize the evolution of neonatal encephalopathy over time, the deferral of opinions on outcome until at least 1 week of age, the role of seizures, and ancillary tests including EEG, evoked potentials, and imaging studies. Apgar scores and cord pH are used solely to define perinatal asphyxia and not for the purpose of prognostication. The severity of the encephalopathy as judged by neurologic signs and ancillary tests is the chief criterion for outcome, and the predictive value of neurologic signs is increased the longer the examination is deferred.