Neurological examination of preterm infants at term equivalent age

Early Hum Dev. 2008 Nov;84(11):751-61. doi: 10.1016/j.earlhumdev.2008.05.007. Epub 2008 Jul 9.


Background: We previously reported the neurological findings of the Dubowitz neonatal examination in a cohort of 157 low-risk preterms born between 25 and 33 weeks gestational age (GA) and examined at term equivalent age (TEA). Median and range of scores were wider than those found in term-born infants and preterms showed a different neurological behaviour in specific items. However, the cohort number was too small to draw any definitive conclusion about the distribution of findings.

Aims: We provide normative data from a low-risk cohort of 380 preterm infants; we also assess the findings and their relationship to motor outcome in preterms with major cranial ultrasound (US) abnormality.

Study design: We assessed, at TEA, 380 low-risk preterms born <35 weeks gestation (range 25-34.9, median 29) with normal 2 year motor outcome and 85 preterm infants with major US abnormality.

Results: At TEA low-risk preterms had less flexor limb tone, poorer head control but better visual following than term-born infants. For 28/34 of the neurological items the range and median scores were similar across gestational ages. In infants with major US lesions the range and median scores differed from low-risk preterms in 20/34 items; 40% of infants developing a diplegia and 80% developing a tetraplegia had >7 items outside the 90th centile; all infants with >12 items outside the 90th centile developed a tetraplegia.

Conclusions: We provide reference values for the neurological examination of low-risk preterms at TEA. In infants with major US abnormality the number of items outside the 90th centile was an indicator of outcome severity.

Publication types

  • Multicenter Study

MeSH terms

  • Cohort Studies
  • Gestational Age
  • Humans
  • Infant Behavior / physiology*
  • Infant, Newborn
  • Infant, Premature / physiology*
  • Muscle Tonus / physiology
  • Neurologic Examination / methods*
  • Posture / physiology
  • Prospective Studies