Optimality scores for the neurological examination of healthy infants at age 6 and 10 weeks in the Tshwane District of South Africa

Abstract BackgroundThe neurodevelopmental progress of infants (age below 3 months) is globally not well described, and a lack of published data on normative values of child development in this age group has been identified. In South Africa, the description of neurodevelopmental characteristics of infants at well-baby 6- and 10-week visits are omitted from the ‘Road to Health Booklet’, a nationally used patient-held clinical record. The neurodevelopmental status of infants in these age groups is thus not routinely monitored and the data is not documented. Important changes occur in the maturation of the central nervous system of infants at 6 weeks that signify this age as an important milestone for monitoring neurodevelopmental progress. Methodology and findingsA prospective longitudinal study was performed on a sample of 35 term-born healthy, infants from low-risk pregnancies at 6- and 10-weeks postnatal age in the Tshwane District, South Africa. The Hammersmith Neonatal Neurological Examination systematically recorded the status of posture, tone, reflexes, movements, orientation and behaviour in these age groups. Compound and total examination optimal scores were derived from raw scores of 34 neurological items in the proforma evaluation form by using cut-off points on the 5th, 10th, and 90th percentiles. Infants who attended both the 6- and 10-week clinic visits were included. This study quantitatively confirmed consistent patterns of characteristic change occurring in muscle tone, posture, and visual behaviour of infants between 6 and 10 weeks. Conclusion and significanceThis study successfully recorded data on the neurodevelopmental assessment of infants from low-risk pregnancies at 6- and 10-weeks post-term age in Tshwane District, South Africa. The compound and total examination optimality scores obtained in this study can presently guide health care professionals using this method of examination in the early identification of adverse neurological signs in such young infants.