Gestational Age-Specific Distribution of the Hammersmith Neonatal Neurological Examination Scores Among Low-Risk Neonates in Ghana

Harriet L S Lawford; Mercy A Nuamah; Helen G Liley; Anne Cc Lee; Felix Botchway; Sailesh Kumar; IMPRINT Study Group; Andrew A Adjei; Samudragupta Bora

doi:10.1016/j.earlhumdev.2020.105133

Gestational Age-Specific Distribution of the Hammersmith Neonatal Neurological Examination Scores Among Low-Risk Neonates in Ghana

Early Hum Dev. 2021 Jan:152:105133. doi: 10.1016/j.earlhumdev.2020.105133. Epub 2020 Aug 15.

Authors

Harriet L S Lawford¹, Mercy A Nuamah², Helen G Liley¹, Anne Cc Lee³, Felix Botchway⁴, Sailesh Kumar¹; IMPRINT Study Group; Andrew A Adjei⁴, Samudragupta Bora⁵

Affiliations

¹ Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia.
² Department of Obstetrics and Gynaecology, University of Ghana Medical School, College of Health Sciences, Korle Bu Teaching Hospital, Accra, Ghana.
³ Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Department of Pathology, University of Ghana Medical School, College of Health Sciences, Korle Bu Teaching Hospital, Accra, Ghana.
⁵ Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia. Electronic address: samudragupta.bora@mater.uq.edu.

PMID: 33249301
DOI: 10.1016/j.earlhumdev.2020.105133

Abstract

Objective: To describe gestational age-specific distribution of scores for the Hammersmith Neonatal Neurological Examination (HNNE) up to 48 h after birth in a low-risk, term-born, single-center sample in Ghana.

Study design: This is a nested substudy of a larger prospective study (IMPRINT: Impact of Malaria in Pregnancy on Infant Neurodevelopment) comprising 140 low-risk, term-born neonates at Korle Bu Teaching Hospital in Accra, Ghana, between November 2018 and February 2019. The sample was stratified into three gestational age groups: early-term (37 + 0-38 + 6, weeks + days; n = 61), full-term (39 + 0-40 + 6, weeks + days; n = 52), and late/post-term (41 + 0-42 + 6, weeks + days; n = 27). Neonates were administered the 34-item HNNE by trained physicians. As per the original British scoring system, raw scores for the Ghanaian sample were plotted and scores > 10th centile were assigned a score of 1, 5th-10th centile 0.5, and < 5th centile 0.

Results: The range of raw scores for 16/34 HNNE items varied with gestational age. Specifically, 100% (7/7), 50% (5/10), 33% (1/3), 33% (1/3), 20% (1/5), and 14% (1/7) of items within the orientation and behavior, tone, abnormal signs/patterns, movements, tone patterns, and reflexes subdomain, respectively showed a different distribution of scores above the 10th centile across the three gestational age groups.

Conclusion: Differences in gestational age-specific results within our sample in comparison to the original British sample could be, albeit unlikely, due to misclassification of gestational age, unmeasured maternal or fetal morbidity, or perhaps more likely, variation in testing or test conditions, or some combination of these. Genetic variation in neurological development is also a possibility. Further research is warranted to determine the reasons for differences. Our findings highlight the need to determine the accuracy and reliability of standardized neurologic assessments in predicting neurodevelopmental risk for infants in low- and middle-income countries.

Keywords: Brain; Low- and middle-income countries; Neonatal neurology; Sub-Saharan Africa.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Female
Gestational Age*
Ghana / epidemiology
Humans
Infant
Infant, Newborn
Neurologic Examination
Pregnancy
Prospective Studies
Reproducibility of Results