The Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) assesses the neurological integrity, behavioural functioning, and responses to stress in high-risk infants using 45 items compared with norms for healthy term infants (n = 125). The NNNS provides an in-depth assessment of neurobehaviour and gives summary scores/subscales for attention, handling, quality of movement, regulation, nonoptimal reflexes, arousal, hypertonicity, hypotonicity, asymmetrical reflexes, excitability and lethargy.
The Hammersmith Neonatal Neurologic Examination (HNNE) consists of 34 individual items with 6 subtotals including tone, tone patterns, reflexes, spontaneous movements, abnormal neurological signs and behaviour in newborns. It provides an overall “optimality score” which has been validated in healthy term (n = 224) and preterm (n = 380) infants. This assessment tool is used frequently in clinical practice and requires no formal training.
Prechtl’s General Movements (GMs) assessment is a non-invasive method for assessing global neurological development, particularly motor development. Video recordings are made of spontaneous whole body movements and assessed at a later time by independent assessors. GMs during the neonatal period have been shown to be predictive of cerebral palsy from birth in the preterm infant. This assessment has the advantage of obtaining an overall picture of neurological integrity without needing to handle the infant.
The Premie-neuro is a brief neurological examination for preterm infants aged 23–37 weeks’ gestation. Consists of 24 items divided into neurological, movement and responsiveness subgroups. Validity has been shown in a small study (n = 34), however the inter-rater reliability was low.