Elsevier

Pediatric Neurology

Volume 27, Issue 3, September 2002, Pages 196-212
Pediatric Neurology

Original article
Update of the amiel-tison neurologic assessment for the term neonate or at 40 weeks corrected age

https://doi.org/10.1016/S0887-8994(02)00436-8Get rights and content

Abstract

Amiel-Tison neurologic assessment at term has recently been updated for clinical application. Experience in this field, in addition to a better understanding of pathophysiologic characteristics of the immature brain, has taught us that an increased precision in assessing central nervous system function in the neonate is compatible with a simplification of the clinical instrument. The complete procedure takes approximately 5 minutes. A simple 0, 1, and 2 scoring system is proposed. Because this coding system is not quantitative, any computation of quotient or total score is inappropriate. Rather, a final synthesis based on clusters of signs and symptoms is advisable. A distinct final synthesis is proposed for term newborn infants in the first week of life and for preterm neonates at approximately 40 weeks of age corrected. Clinical profiles emerging from repeated assessments in the term newborn and early clinical findings indicating a brain damage of prenatal origin are described. Interrater reliability has been proved to be more than satisfactory. Such an assessment is useful for any newborn infant in maternity wards or for any preterm infant approximately 40 weeks of age, with or without abnormal imaging findings.

Introduction

Examining neonatal intensive care unit discharge summaries the clinicians’ devaluation is observed all over the world. Abnormal ultrasound findings provide the key to the follow-up clinic, not clinical findings. This failure is a shame, particularly at a time when clinical neurology in the neonate has such a promising future, as expressed by Volpe, “Perhaps of greatest importance is the realization that careful clinico-anatomic correlations are only beginning to be made in neonatal neurology, especially since the advent of high-resolution brain imaging techniques. Further significant insight into the impact of cerebral injury on the neonatal neurological examination is expected to be gained from such correlations” [1].

Because brain damage in the neonate is mainly located in cerebral hemispheres, the best predictive value should be found in responses depending on the upper control system and not in responses depending mainly on brainstem activity. The cerebral maturation around term is such that the upper hemispheric structures can be clinically explored, within the first days of life in a term newborn or at approximately 40 weeks corrected age in a premature newborn.

The Amiel-Tison neurologic assessment at term is an attempt to answer this challenge by (1) substantially increasing clinical accuracy in assessing central nervous system function in the neonate by using a simple scoring system; (2) focusing on the most meaningful items, eliminating those that appear redundant; (3) promoting a clinical synthesis at term, for term and preterm infants, not defined as the sum of individual scores but as a gradation system based on clusters of signs and symptoms.

Section snippets

Initial description and later simplification

Largely influenced by his background in adult neurology, André-Thomas in Paris [2] was fascinated by brainstem activity, which is so conspicuous in the term newborn infant because of the immaturity of the upper control system at this stage of maturation. He defined passive and active tone and considered tone changes to be valuable clinical signs. As a young neonatalogist, I had the opportunity in the early 1960s to observe his disciple, Saint-Anne Dargassies, assessing neonates in

General remarks

The record form presented here as an Appendix is aimed to replace the form previously used [10], [12]. Because no new items have been added to preceding descriptions, the technical definitions may be found in various didactic texts [5], [15], [19], [37].

Corrected age is used for children born before 37 weeks gestation. To obtain corrected age, postnatal weeks are added to weeks of gestation. For example, when a child born at 36 weeks gestation is assessed 4 weeks after birth, his/her corrected

Conclusion

Why have we been so slow in the systematic application of the experience acquired by the pediatricians and neurologists in this field? It may be a result of the lack of self-confidence of many pediatricians in their ability to test central nervous system function at this age. Alternatively, it may be a result of the lack of confidence of many neurologists in the ability of the neonates themselves to demonstrate the quality of their higher cerebral functions or the complexity of the available

Acknowledgements

I want to thank Julie Gosselin for the help she generously provided at each step of the preparation of this manuscript and the assessment checklist.

References (49)

  • C. Amiel-Tison et al.

    Cerebral handicap in full-term neonates related to the mechanical forces of labour

    Baillère’s Clin Obstet Gynaecol

    (1988)
  • G. Cioni et al.

    Comparison between observation of spontaneous movements and neurologic examination in preterm infants

    J Pediatr

    (1997)
  • Volpe JJ. Neurological examination: Normal and abnormal features. In: Neurology of the newborn, 4th ed. Philadelphia:...
  • Chesni Y. André-Thomas et al.

    The neurological examination of the infant

    Clin Dev Med

    (1960)
  • Saint-Anne Dargassies S. Neurological development in the full-term and premature neonate. Amsterdam: Elsevier,...
  • Sarnat HB. Anatomic and physiologic correlates of neurologic development in prematurity. In: Sarnat HB, ed. Topics in...
  • C. Amiel-Tison

    Clinical assessment of the infant nervous system

  • C. Amiel-Tison

    Does neurological assessment still have a place in the NICU?

    Acta Padiatr

    (1996)
  • C. Amiel-Tison

    Cerebral damage in fullterm newborn. Aetiological factors, neonatal status and long term follow-up

    Biol Neonat

    (1969)
  • C. Daum et al.

    Preterm development of visual and auditory orienting in very low birthweight infants

    Pediatr Res

    (1980)
  • C. Amiel-Tison et al.

    A new neurologic and adaptive capacity scoring system for evaluating obstetric medication in full-term newborns

    Anesthesiol

    (1982)
  • C. Amiel-Tison

    Birth injury as a cause of brain dysfunction in fullterm newborns

  • C. Amiel-Tison et al.

    Birth asphyxia in the full term newborn. Early assessment and outcome

    Dev Med Child Neurol

    (1986)
  • C. Amiel-Tison

    Neurological morbidity of term infants as an indicator of safe obstetrical practice

  • C. Amiel-Tison et al.

    Safety of fullterm birth

  • Amiel-Tison C, Grenier A. Neurological assessment during the first year of life. New York: Oxford University Press,...
  • F. Lebrun et al.

    Sécurité de la naissance à terme et taux de césarienne

  • P.N. Amess et al.

    Early brain proton magnetic resonance spectroscopy and neonatal neurology related to neurodevelopmental outcome at 1 year in term infants after presumed hypoxic-ischemic brain injury

    Dev Med Child Neurol

    (1999)
  • C. Amiel-Tison et al.

    Follow-up studies during the first five years of lifeA pervasive assessment of neurological function

    Arch Dis Child

    (1989)
  • Amiel-Tison C, Gosselin J. How to fill out the examination chart. In: Neurological development from birth to 6 years....
  • Peiper A. Cerebral function in infancy and childhood (translation of the 3d revised German edition by Nagler B & Nagler...
  • H.F.R. Prechtl

    The neurological examination of the fullterm newborn infant

    Clin Dev Med

    (1977)
  • P.H. Wolff

    Visual pursuit and attention in young infants

    J Am Acad Child Psychiatry

    (1965)
  • P.H. Wolff

    The serial organization of sucking in the young infant

    Pediatrics

    (1968)
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