Abstract
ObjectiveTo test the inter-rater reliability of the modified Sarnat neurologic examination in preterm neonates and to correlate abnormalities with the presence of perinatal acidosis.MethodsProspective study of 32–36 weeks’ gestational age infants admitted to the neonatal intensive care unit. Each infant had two Sarnat examinations performed at <6 h, one by a gold standard (GS) study investigator, and the second either by (a) another GS examiner or (b) an attending physician (28 examiners), all blinded to clinical variables. Agreement was calculated using kappa (k) statistics.ResultsOne hundred and two (9, fetal acidosis) infants underwent a modified Sarnat examination. Among GS examiners, agreement was excellent (k > 0.8) except for Moro, while among all examiners agreement was very good (k > 0.7) except for both Moro and tone. Subgroup analysis at 32–34 weeks’ showed fair/poor Moro compared to excellent agreement at ≥35 weeks. Increasing abnormalities correlated with acidosis (r = −0.6, P < 0.01).ConclusionsStrong inter-rater reliability for the modified Sarnat was observed except for tone and Moro in preterm infants. Experience of the examiners resulted in improved reliability in tone, while for the Moro agreement improved only beyond 35 weeks. Findings suggest the need of adjustment of the examination form specific for preterm infants.
Highlights
Clinical examination remains the most effective way to assess neonatal neurological status as it evaluates the integrity of the nervous system
Of the 1180 newborns of 32–36 weeks’ gestation admitted to the neonatal intensive care unit (NICU) during the study period, 102 (9%) were enrolled and underwent a modified Sarnat examination performed by two examiners within the first 6 h of age, and within 20 min from each examination
Of the 102 infants, 9 (9%) had perinatal acidosis based on umbilical cord arterial blood gas values
Summary
Clinical examination remains the most effective way to assess neonatal neurological status as it evaluates the integrity of the nervous system. The neurologic assessment of the newborn is challenging due to transient effects of delivery, need of resuscitation, general anesthesia, and/or the presence of other associated conditions, such as respiratory distress.. The neurologic assessment of the newborn is challenging due to transient effects of delivery, need of resuscitation, general anesthesia, and/or the presence of other associated conditions, such as respiratory distress.1,2 These challenges are further amplified in preterm infants who can present with a complex amalgam of asphyxia and secondary maturational disturbances.. It has since been modified to allow enrollment of newborns with hypoxic–ischemic encephalopathy (HIE) in studies of neuroprotective therapies within 6 h of life. While the modified Sarnat examination has been extensively tested in the evaluation of term newborns at risk for encephalopathy, no prior studies have tested its inter-rater reliability in preterm infants.
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