OBJECTIVE To describe the results of the Hammersmith Neonatal Neurological Examination (HNNE) in a low-risk, term-born, contemporary sample in Ghana. Of particular interest was to compare these findings with the original British study that validated the HNNE, and published data from other low- and middle-income countries. STUDY DESIGN In a nested substudy of a larger prospective study (IMPRINT: Impact of Malaria in Pregnancy on Infant Neurodevelopment), 140 low-risk, term-born neonates (39.3 ± 1.4 weeks gestation) at Korle Bu Teaching Hospital in Accra, Ghana were administered the 34-item HNNE from birth to 48 h of age by trained physicians. Neonates' performance was compared with previously published normative data from the United Kingdom (1998), and published data from Thailand, Myanmar, Vietnam, and Uganda. RESULTS Ghanaian neonates demonstrated lower scores on 30/34 HNNE items relative to normative data from the United Kingdom (P < .05), with only 5% of Ghanaian neonates in our sample classified as neurologically optimal. There were significant differences in the proportion of neonates scoring optimally per HNNE item between our Ghanaian sample, compared to published data from other settings (Thai [13/16 items], Burmese [14/16 items], Vietnamese [7/9 items], and Ugandan [22/34 items] neonates). Raw scores were markedly different between Ghanaian and British neonates, with Ghanaian neonates demonstrating lower median and wider range of scores. These differences were less prominent between Ghanaian and Ugandan neonates. CONCLUSION Our findings raise questions as to whether or not the thresholds for optimality for the HNNE based on data from the United Kingdom are applicable to Ghanaian newborns. Our study could not fully resolve whether the differences in scores were due to genetic differences in developmental pathways, the implementation of the assessment, or the characteristics of our sample. Low proportions of neonates scoring optimally from other low- and middle-income countries suggest the need for further research to determine the clinical utility of the HNNE in resource-limited settings, including the predictive value for neurodevelopment later in infancy.

中文翻译：

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资源有限环境中的新生儿神经系统检查：正常的定义是什么？

目的 描述哈默史密斯新生儿神经学检查 (HNNE) 在加纳低风险、足月出生的当代样本中的结果。特别感兴趣的是将这些发现与验证 HNNE 的原始英国研究以及其他低收入和中等收入国家公布的数据进行比较。研究设计 在一项大型前瞻性研究（IMPRINT：疟疾对妊娠期疟疾对婴儿神经发育的影响）的嵌套子研究中，加纳阿克拉 Korle Bu 教学医院的 140 名低风险足月新生儿（妊娠 39.3 ± 1.4 周）在由训练有素的医生从出生到 48 小时进行 34 项 HNNE。新生儿的表现与先前公布的英国（1998 年）规范数据以及泰国、缅甸、越南和乌干达公布的数据进行了比较。结果 与来自英国的规范数据相比，加纳新生儿在 30/34 HNNE 项目上的得分较低 (P < .05)，我们的样本中只有 5% 的加纳新生儿被归类为神经学最佳。与来自其他设置（泰国 [13/16 项]、缅甸 [14/16 项]、越南语 [7/9 项]）的已发布数据相比，我们的加纳样本中每个 HNNE 项目获得最佳评分的新生儿比例存在显着差异，和乌干达 [22/34 项] 新生儿）。加纳新生儿和英国新生儿的原始分数显着不同，加纳新生儿的分数中位数较低，分数范围更广。加纳和乌干达新生儿之间的这些差异不太明显。结论 我们的研究结果提出了一个问题，即基于英国数据的 HNNE 最优阈值是否适用于加纳新生儿。我们的研究无法完全确定分数的差异是由于发育途径的遗传差异、评估的实施还是我们样本的特征造成的。来自其他低收入和中等收入国家的新生儿比例较低，这表明需要进一步研究以确定 HNNE 在资源有限环境中的临床效用，包括对婴儿后期神经发育的预测价值。评估的实施，或我们样本的特征。来自其他低收入和中等收入国家的新生儿比例较低，这表明需要进一步研究以确定 HNNE 在资源有限环境中的临床效用，包括对婴儿后期神经发育的预测价值。评估的实施，或我们样本的特征。来自其他低收入和中等收入国家的新生儿比例较低，这表明需要进一步研究以确定 HNNE 在资源有限环境中的临床效用，包括对婴儿后期神经发育的预测价值。