Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 4828
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
LETTER TO EDITOR
Year : 2020  |  Volume : 9  |  Issue : 12  |  Page : 6297-6298  

Comparison between trained specialist and medical student in performing neurological assessment of high-risk infant by Hammersmith infant neurological examination (HINE)


1 Junior Resident, Department of Pediatrics, PGIMS, Rohtak, Haryana, India
2 Assistant Professor, Department of Pediatrics, PGIMS, Rohtak, Haryana, India
3 MBBS Student, PGIMS, Rohtak, Haryana, India

Date of Submission08-Aug-2020
Date of Decision06-Oct-2020
Date of Acceptance20-Oct-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Anjali Verma
117 A, Sector 14, Rohtak, Haryana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_1611_20

Rights and Permissions

How to cite this article:
Lata K, Jindal P, Verma A, Dochania K, Batra R. Comparison between trained specialist and medical student in performing neurological assessment of high-risk infant by Hammersmith infant neurological examination (HINE). J Family Med Prim Care 2020;9:6297-8

How to cite this URL:
Lata K, Jindal P, Verma A, Dochania K, Batra R. Comparison between trained specialist and medical student in performing neurological assessment of high-risk infant by Hammersmith infant neurological examination (HINE). J Family Med Prim Care [serial online] 2020 [cited 2021 May 14];9:6297-8. Available from: https://www.jfmpc.com/text.asp?2020/9/12/6297/305607



A standardized neurological examination is important for evaluation of infants in high-risk infant follow up clinics. The Hammersmith Infant Neurological Examination (HINE)[1],[2] is a simple method for detection of early signs of cerebral palsy in infants between 2 and 24 months of age and it includes assessment of cranial nerve functions, posture, movements, tone and reflexes. Various studies were being done to develop software or use electronic media to improve the performance of this screening tool.[3] HINE not only identifies children at risk of CP but also often provides additional information on the type and severity of the motor sequelae. It often allows identification of early abnormal signs related to other aspects of neurological function such as cerebral visual impairment or feeding abnormalities. Therefore, it also allows better assessment of the overall severity of CP, not limited to motor impairment. Hence appropriate and timely intervention can be planned aiming at the specific component rather than doing a general intervention. Despite its general utility, HINE currently lacks a standardized training or widely available course.

A descriptive cross sectional study was done in Paediatric outpatient unit at a Tertiary care Teaching Hospital to compare the Neurological Assessment of high risk infant by HINE between a specialist and a final year MBBS student having basic knowledge of paediatrics.

Fifty high-risk infants of age group 2-12 months with either history of prematurity or term babies with birth asphyxia were enrolled whereas those with refractory seizures were excluded. The student was trained by paediatric faculty and provided with proper handouts and videos of HINE. First 5 cases done by student were supervised and those cases were not included in the study. After taking proper informed consent from parents, HINE was done on each infant by both student and faculty independently, results were sealed in envelope and later analyzed.

Mean age of infants enrolled was 4.2 months with M: F ratio of 3:2. Out of them, 35 (70%) were term and 15 (30%) were preterm. Out of them, 15 had history of neonatal seizures; 18 had respiratory distress; 7 were ventilated; 5 had apnea and 23 had jaundice during hospital stay. The inter-rater reliability was assessed using a two-way mixed, absolute agreement, single measures Intraclass coefficient (ICC) to find the degree of reliability between the two observers. The ICC value was high (ICC = 0.98, 95% CI, P < 0.001) and value of Cronbach's alpha was high (0.99). It suggests high degree of reliability between the student and the faculty in the scoring of HINE. Although motor milestones were not being scored in HINE but assessment done by both was similar when assessed individually. Behaviour state cannot be compared between the two as the infants were assessed at different time of the day.

We propose that HINE can be done routinely by primary care physician in a resource poor country like ours for early detection and referral of cases of cerebral palsy in the community. Regular training, monitoring and feedback of primary care physician would definitely help in mitigating problems in these children. More studies are also required involving large number of subjects.

Acknowledgements

  1. MRU, PGIMS Rohtak
  2. Dr JS Kaushik for his teaching & training in Pediatric Neurology.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Majnemer A, Rosenblatt B. Prediction of outcome at school age in neonatal intensive care unit graduates using neonatal neurologic tools. J Child Neurol 2000;15:645-51.  Back to cited text no. 1
    
2.
Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, Steichen JJ, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Pediatrics 2000;105:1216-26.  Back to cited text no. 2
    
3.
Dogra D, Nandam K, Majumdar A, Sural S, Mukherjee J, Majumdar B, et al. A user friendly implementation for efficiently conducting Hammersmith infant neurological. In: Proc. 12th Int. Conf. E-Health Networking Applicat. Services; 20101-3, Lyon, France; 2010. p. 374-8.  Back to cited text no. 3
    




 

Top
   
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   References

 Article Access Statistics
    Viewed938    
    Printed2    
    Emailed0    
    PDF Downloaded67    
    Comments [Add]    

Recommend this journal