Official Journal of the European Paediatric Neurology Society Original article Early neurologic assessment in preterm-infants: Integration of traditional neurologic examination and observation of general movements Domenico Marco Maurizio Romeo a , Andrea Guzzetta b,Ã , Mariacristina Scoto a , Matteo Cioni a,c , Pietro Patusi d , Domenico Mazzone a , Mario Giuseppe Romeo e a Division of Child Neurology and Psychiatry, Department of Paediatrics, University of Catania, Italy b Department of Developmental Neuroscience, Stella Maris Scientific Institute, Via dei Giacinti, 2 I-56018 Calambrone Pisa, Italy c Gait and Motion Analysis Laboratory , Department of Experimental & Clinical Pharmacology, University of Catania, Italy d Personal practice, Italy e Neonatal Intensive Care Unit, Department of Paediatrics, University of Catania, Italy article info Article history: Received 23 April 2007 Received in revised form 24 July 2007 Accepted 26 July 2007 Keywords: General movements Hammersmith Infant Neurologic Examination Preterm infant Neurodevelopmental outcome abstract Objective: To evaluate the possible additional benefit in terms of prognostic accuracy of an integrated application of a traditional scorable method of neurologic examination and the Prechtl’s method of qualitative assessment of general movements (GMs) in a large population of 903 consecutive preterm infants. Study design: Infants were enrolled from the Intensive Care Unit of the University of Catania. Inclusion criteria were a gestational age below 37 weeks and the absence of genetic disorders. All infants underwent serial ultrasound and at 3 months performed both the GMs assessment and the Hammersmith Infant Neurologic Examination (HINE). Outcome was assessed at 2 years by the Touwen neurologic examination and the Clinical Adaptive Test/Clinical, Linguistic and Auditory Milestone Scale. Results: The integration of the two methods was shown to be more effective than the single assessments in predicting neurologic outcome. The additional benefit of combining the two approaches was particularly clear for the discrimination between unilateral and bilateral cerebral palsy. Conclusions: The integrated use of a scorable neurological examination and Prechtl’s assessment of GMs can improve early prediction of neurodevelopmental outcome in preterm infants and should complement other clinical and instrumental exams in follow- up programs. & 2007 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved. ARTICLE IN PRESS 1090-3798/$ - see front matter & 2007 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ejpn.2007.07.008 Ã Corresponding author. Tel.: +39 050 886323; fax: +39 050 32214, +39 050 886247. E-mail address: a.guzzetta@inpe.unipi.it (A. Guzzetta). Abbreviations: GMs; general movements; HINE; Hammersmith Infant Neurologic Examination; CP; cerebral palsy; MD; mild disability; CAT/CLAMS; Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale; PTA; post-term age; FMs; fidgety movements; US; ultrasounds EUROPEAN JOURNAL OF PAEDIATRIC NEUROLOGY 12 (2008) 183– 189