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