Neurologic examination of the newborn
- Suresh Kotagal, MD
Suresh Kotagal, MD
- Professor of Neurology, Mayo Clinic
- Consultant in Neurology, Pediatrics, and Sleep Medicine
- Section Editors
- Joseph A Garcia-Prats, MD
Joseph A Garcia-Prats, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
A comprehensive neurologic assessment should be performed in any newborn suspected to have central or peripheral nervous system dysfunction, either based upon history (eg, perinatal asphyxia) or a physical finding detected during the routine neonatal assessment (eg, a weak and immobile upper extremity). (See "Assessment of the newborn infant", section on 'Neurologic examination'.)
There are a number of publications that describe the newborn neurologic examination [1-15]. The discussion on the neonatal neurologic assessment presented here is based upon a review of the literature and the experience of the author. Other aspects of the routine assessment of the newborn are discussed separately. (See "Assessment of the newborn infant".)
The goals of the neurologic examination are to recognize emergent issues like status epilepticus, assist in localization of the disturbance, establish a diagnosis, and, to some extent, help in predicting the long-term outcome .
The following factors may alter the results of the neurologic examination and must therefore be taken into consideration:
●Conceptional age (CA; ie, gestational age [GA] plus postnatal age) of the infant − The normal neurologic examination changes with maturation. In particular, passive tone and posture vary with GA and are used by the Ballard score to assign GA (figure 1 and table 1). (See "Postnatal assessment of gestational age", section on 'New Ballard score' and 'Passive tone/posture' below.)
- Amiel-Tison C. Neurological evaluation of the maturity of newborn infants. Arch Dis Child 1968; 43:89.
- Brazelton T, Nugent K. Neonatal Behavior Assessment Scale, 3rd ed, Mac Keith Press, London 1995.
- Dubowitz LMS, Dubowitz V, Mercuri E. The neurological assessment of the preterm and full-term infant, 2nd ed, Mac Keith Press, London 1999.
- Prechtl H. The neurological examination of the full term infant, 2nd ed, London 1977.
- Sheridan-Pereira M, Ellison PH, Helgeson V. The construction of a scored neonatal neurological examination for assessment of neurological integrity in full-term neonates. J Dev Behav Pediatr 1991; 12:25.
- Als H, Lester B, Tronick E, Brazelton TB. Manual for the assessment of preterm infants' behavior (APIB). In: Theory and Research in Behavioral Pediatrics, Fitzgerald H, Lster B, Yogman M (Eds), Plenum Press, New York p.65.
- Morgan AM, Koch V, Lee V, Aldag J. Neonatal neurobehavioral examination. A new instrument for quantitative analysis of neonatal neurological status. Phys Ther 1988; 68:1352.
- Campbell SK, Hedeker D. Validity of the Test of Infant Motor Performance for discriminating among infants with varying risk for poor motor outcome. J Pediatr 2001; 139:546.
- Prechtl H. The neurological examination of the full term newborn infant. Clinics in Developmental Medicine, No. 63, Spastics International Medical Publications, London 1977.
- Kroner A, Thom VA. Neurobehavioral assessment of the preterm infant, The Psychological Corporation, New York 1991.
- Swaiman KF. Neurological examination of the term and preterm infant. In: Principles and Practice, 4th ed, Swaiman KF, Ashwal S, Ferriero DM (Eds), Mosby Elsevier, Philadelphia 2006. p.47.
- Paine RS. Neurological examination of infants and children. Pediatr Clin North Am 1960; 7:41.
- Majnemer A, Mazer B. Neurologic evaluation of the newborn infant: definition and psychometric properties. Dev Med Child Neurol 1998; 40:708.
- Volpe JJ. The neurological examination: normal and abnormal features. In: Neurology of the newborn, Saunders/Elsevier, Philadelphia 2008. p.121.
- Larsen PD, Stensass SS. PediNeurologic Exam. University of Utah School of Medicine, 2005, http://library.med.utah.edu/pedineurologicexam (Accessed on May 27, 2014).
- Bax M. Neurological examination of the newborn. Dev Med Child Neurol 1998; 40:651.
- Prechtl HF, Einspieler C, Cioni G, et al. An early marker for neurological deficits after perinatal brain lesions. Lancet 1997; 349:1361.
- Romeo DM, Guzzetta A, Scoto M, et al. Early neurologic assessment in preterm-infants: integration of traditional neurologic examination and observation of general movements. Eur J Paediatr Neurol 2008; 12:183.
- Sarnat HB. Olfactory reflexes in the newborn infant. J Pediatr 1978; 92:624.
- Shevell M. The tripartite origins of the tonic neck reflex: Gesell, Gerstmann, and Magnus. Neurology 2009; 72:850.
- Zafeiriou DI. Primitive reflexes and postural reactions in the neurodevelopmental examination. Pediatr Neurol 2004; 31:1.
- Sheppard JJ, Mysak ED. Ontogeny of infantile oral reflexes and emerging chewing. Child Dev 1984; 55:831.
- Allen MC, Capute AJ. The evolution of primitive reflexes in extremely premature infants. Pediatr Res 1986; 20:1284.
- Capute AJ, Palmer FB, Shapiro BK, et al. Primitive reflex profile: a quantitation of primitive reflexes in infancy. Dev Med Child Neurol 1984; 26:375.
- Futagi Y, Suzuki Y, Goto M. Clinical significance of plantar grasp response in infants. Pediatr Neurol 1999; 20:111.
- Nelson KB, Ellenberg JH. Neonatal signs as predictors of cerebral palsy. Pediatrics 1979; 64:225.
- Allen MC, Capute AJ. Neonatal neurodevelopmental examination as a predictor of neuromotor outcome in premature infants. Pediatrics 1989; 83:498.
- Maas YG, Mirmiran M, Hart AA, et al. Predictive value of neonatal neurological tests for developmental outcome of preterm infants. J Pediatr 2000; 137:100.
- GENERAL EVALUATION
- - Level of alertness
- - Head size
- - Fontanel
- - Sutures
- - Scalp swelling
- - Auscultation
- - Transillumination
- Associated findings
- MOTOR FUNCTION
- Passive tone/posture
- Active muscle function
- - Prechtl system
- Abnormal motor exam
- - Hypotonia
- - Hypertonia
- CRANIAL NERVES
- CN I and XI
- Cranial nerve II
- CN III, IV, and VI
- - Abnormal eye movements
- Cranial nerve V
- Cranial nerve VII
- Cranial nerve VIII
- - Cranial nerves IX and X
- Cranial nerve XII
- BEHAVIORAL EVALUATION
- INTERPRETATION AND PROGNOSIS
- SUMMARY AND RECOMMENDATIONS