Hammersmith Infant Neurological Examination Research Articles

Maternal obesity, gestational diabetes mellitus, and diet in association with neurodevelopment of 2-year-old children

BackgroundMaternal metabolic disturbances and diet may influence long-term infantile neurodevelopment. We investigated whether maternal gestational diabetes mellitus (GDM), obesity, and diet could affect the neurodevelopment of 2-year-old children.MethodsNeurodevelopment of children (n = 243) born to mothers with overweight or obesity was assessed with the Bayley Scales of Infant and Toddler Development–Third Edition, and the Hammersmith Infant Neurological Examination. Maternal adiposity was determined by air displacement plethysmography, and GDM with an oral glucose tolerance test. Dietary assessment included diet quality and fish consumption questionnaires, and three-day food diaries, from which dietary inflammatory index (DII®) scores were computed.ResultsGDM was associated with weaker expressive language skills (adj.β = −1.12, 95% CI = −2.10;−0.15), and higher maternal adiposity with weaker cognitive, language, and motor skills in children (adj.p < 0.05). Maternal good dietary quality (adj.β = 0.87, 95% CI = 0.004;1.73) and higher fish consumption (adj.p = 0.02) were related to better expressive language skills. DII scores were not associated with children’s neurodevelopment.ConclusionsFindings suggest that GDM and higher maternal adiposity may lead to weaker neurodevelopmental skills, although still within the mean normative range in this population of children. Good dietary quality and higher fish consumption during pregnancy could benefit a child’s language development.ImpactGestational diabetes mellitus and maternal higher adiposity may have unfavorable effects on a 2-year-old child’s neurodevelopment.An overall good quality of diet and higher fish consumption during pregnancy may result in more favorable cognitive and language skills when the child is 2-year-old.Our findings reveal that women with overweight or obesity, a risk group for pregnancy complications, could benefit from dietary counseling to support their children’s neurodevelopment.

Early Electroencephalogram as Predictor of Neuromotor Outcome in a Term Newborn with Hypoxic Ischaemia Encephalopathy- A Prospective Cohort Study

Introduction: Birth asphyxia is the leading cause of neonatal morbidity and mortality globally. Early prediction of neuromotor problems in babies with Hypoxic Ischaemic Encephalopathy (HIE) allows parental counseling regarding treatment continuation, better utilisation of limited resources and prompt referral for early intervention services to so that the best possible outcomes can be achieved. Aim: To investigate the role of early Electroencephalogram (EEG) background activity in prediction of cerebral palsy, epilepsy and developmental delay in term newborn with HIE and also to check the association of EEG background activity with Hammersmith Neonatal Neurological Examination (HNNE), Hammersmith Infant Neurological Examination (HINE) score and various short-term and long-term outcome. Materials and Methods: This prospective clinical study was conducted in Neonatal Intensive Care Unit (NICU) of Department of Paediatrics, Shyam Shah Medical college and associated Gandhi Memorial Hospital, Rewa (MP) during April 2019 to June 2020. Total 81 term neonates with HIE underwent conventional EEG within six hours of birth using International 10-20 system, (modified for neonate) for electrode placement. At the time of discharge HNNE was performed. On follow-up (6 to 12 months), cerebral palsy was evaluated using HINE and modified Ashworth score, Developmental delay by Development Assessment Scale for Indian Infant (DASII) scale and for epilepsy by clinical history and EEG background activity. Association between EEG background activity, HNNE, HINE score and various short-term and long-term outcome was calculated using Chi-square test and Fisher’s-exact test. Results: In present study, out of 81 cases, 58 (71.6%) cases were male and 23 (28.4%) cases were female with mean Gestational Age (GA) of 39 weeks. A total of 57 neonates were discharged successfully after stay of mean duration 13.8 days in NICU. All neonates with normal/mildly abnormal EEG background activity had 100% survival rates whereas only 68.2% (15) and 37% (10) could be discharged from moderately abnormal and severely abnormal EEG background activity group. Out of discharged patients none with severely abnormal background had optimal HNNE whereas 75% (24) of mildly abnormal EEG had optimal HNNE score. Mean HNNE and HINE score was significantly lower in newborns with severely abnormal EEG (mean score 20.8) as compared to normal EEG group (mean score 30.3). Severely abnormal EEG at birth had significant association with cerebral palsy (p-value&lt;0.0001), epilepsy (p-value= 0.003) and developmental delay (p-value&lt;0.001) as compared to moderately and mildly abnormal EEG background activity in newborns with HIE. Conclusion: EEG within six hours of birth in term neonate with HIE has very high sensitivity and Negative Predictive Value (NPV) in predicting short-term outcome as death, poor neurological outcome and long-terms outcome as cerebral palsy, epilepsy and developmental delay.

Nusinersen for Spinal Muscular Atrophy Type I with Chronic Respiratory Failure: A Retrospective Study in South Korea.

To analyze the efficacy and safety of nusinersen in patients with spinal muscular atrophy (SMA) type I with chronic respiratory failure. We retrospectively reviewed seven patients diagnosed with SMA type I and chronic respiratory failure who were on permanent ventilation and treated with nusinersen at Gangnam Severance Hospital between January 2018 and July 2023. Patient demographics and clinical characteristics were recorded, and treatment progress was evaluated according to Hammersmith Infant Neurological Examination (HINE-2) and Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) scores. Patients initially developed hypotonia at a mean age of 3.7 months. Mean age at start of nusinersen was 7.3 years; the mean duration of follow-up after starting nusinersen was 46.2 months. At 6-, 18-, 38-, 58-, and 74-month follow-up, the mean changes in CHOP-INTEND scores were 1.0, 2.9, 1.8, 1.5, and 1.5, respectively, and the proportions of patients who showed disease amelioration were 28.6%, 71.4%, 75.0%, 100%, and 100%, respectively. Nusinersen is safe and effective in patients with SMA type I, even those with chronic respiratory failure and those on permanent ventilation. No significant adverse effects of nusinersen were observed.

The developing brain: Challenges and opportunities to promote school readiness in young children at risk of neurodevelopmental disorders in low- and middle-income countries.

This paper discusses possibilities for early detection and early intervention in infants with or at increased risk of neurodevelopmental disorders in low- and middle-income countries (LMICs). The brain's high rate of developmental activity in the early years post-term challenges early detection. It also offers opportunities for early intervention and facilitation of school readiness. The paper proposes that in the first year post-term two early detection options are feasible for LMICs: (a) caregiver screening questionnaires that carry little costs but predict neurodevelopmental disorders only moderately well; (b) the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment (SINDA) which are easy tools that predict neurodisability well but require assessment by health professionals. The young brain's neuroplasticity offers great opportunities for early intervention. Ample evidence indicates that families play a critical role in early intervention of infants at increased risk of neurodevelopmental disorders. Other interventional key elements are responsive parenting and stimulation of infant development. The intervention's composition and delivery mode depend on the infant's risk profile. For instance, in infants with moderately increased risk (e.g., preterm infants) lay community health workers may provide major parts of intervention, whereas in children with neurodisability (e.g., cerebral palsy) health professionals play a larger role.

Long-term predictivity of early neurological assessment and developmental trajectories in low-risk preterm infants.

Prematurity represents 10.6% of all births, and although preterm infants usually show adequate neurodevelopmental outcomes, some may develop significant and long-lasting neurological sequelae. Many studies have analyzed predictive factors for developing severe neurodevelopmental impairments (cerebral palsy, other motor and socio-relational disorders such as autism). In this study, 148 preterm infants were enrolled to investigate the neurodevelopmental trajectories in a population of low-risk premature infants using standardized assessment methods. Significant correlations were found between the general movements, the Hammersmith Infant Neurological Examination, and the Griffiths Mental and Development Scales. Moreover, this study showed their validity and predictivity for adverse neurodevelopmental outcomes even in low-risk infants.

Predictive value of the test of infant motor performance and the Hammersmith infant neurological examination for cerebral palsy in infants

BackgroundCurrent recommendations for early detection tools for cerebral palsy (CP) include assessments that vary in feasibility and resource requirements. The predictive value of less resource-intensive tools has not been fully explored. AimsTo determine the predictive value of the Test of Infant Motor Performance (TIMP) at 3–4 months corrected age (CA) for CP, and whether administration of both the TIMP and the Hammersmith Infant Neurological Exam (HINE) improves early CP detection. Study designFive-year retrospective observational study of infants who received the TIMP and the HINE at 3–4 months CA in a high-risk follow-up clinic. TIMP and HINE cut-off scores (alone and in combination) were compared for CP discriminatory ability. SubjectsOf patients with HINE scores (n = 1389; 676 [48.7 %] female; median gestational age at birth 31 weeks [interquartile range 29–34 weeks]), 1343 had concurrent TIMP scores available. Outcome measuresClinical diagnosis of CP. ResultsHINE total score <57 had optimal CP predictive value (AUC = 0.815; 77 % sensitivity; 91 % specificity) compared to optimal TIMP cut-off (1 SD below the mean, AUC = 0.71; 52 % sensitivity; 94 % specificity) and all tested TIMP and HINE combinations (all p < 0.001). ConclusionsHINE total score <57 at 3–4 months CA had the best CP predictive value, confirming its value absent first-line detection tools. Concurrent administration of TIMP did not improve predictive value.

Accuracy of the Hammersmith infant neurological examination for the early detection of neurological changes in infants exposed to Zika virus: A case-cohort study.

The Hammersmith infant neurological examination (HINE) is a highly predictive tool for the easy and low-cost detection of cerebral palsy. Between 2015 and 2016, the rapid spread of the Zika virus (ZIKV) in Brazil was responsible for an increase in microcephaly cases. This study aimed to verify the accuracy of the HINE for the early detection of neurological problems in Brazilian babies exposed to ZIKV.This was a cross sectional case-control study of children exposed to ZIKV. This study was part of the Jundiaí ZIKV Cohort. Of a total sample of 782 children, 98 were evaluated (26 in the exposed group and 63 in the control group). We included late preterm infants and term infants who were exposed to the ZIKV and were participants in the ZIKV Cohort study. Student's t-test and stepwise multivariate logistic regression were used to compare groups.Of the 26 items evaluated in the five scored categories of the HINE (cranial nerve function, posture, movements, tone, reflexes, and reactions), only the difference in ankle dorsiflexion between the exposed and the control groups was statistically significant. However, some items showed a significant trend in relation to the control group.Our results demonstrated the importance of early neurological assessment of infants exposed to ZIKV, even in those without a microcephaly diagnosis.

Early Diagnosis of Cerebral Palsy in Low- and Middle-Income Countries.

Cerebral palsy describes a group of permanent disorders of movement, motor function and posture that occur due to non-progressive insults to the developing brain. Most of the information concerning the early diagnosis of cerebral palsy originates from studies conducted in high-income countries. In this scoping review, we aimed to explore the tools used in low- and middle-income countries for the early diagnosis of cerebral palsy. A systematic search was conducted using OVID Medline and PubMed databases. “Early diagnosis” was defined as diagnosis prior to 12 months of age, and low- and middle-income countries were classified according to the World Bank classification system. We identified nine studies on the early diagnosis of cerebral palsy from low- and middle-income countries. The tools featured (n = number of studies) were: General Movement Assessment (6), neonatal magnetic resonance imaging (3), Hammersmith Neonatal Neurological Examination (2), Hammersmith Infant Neurological Examination (1) and cranial ultrasound (1). We found a paucity of published literature on the early diagnosis of cerebral palsy from low- and middle-income countries. Further research is needed to determine the tools that are accurate and feasible for use in low-resource settings, particularly since cerebral palsy is more prevalent in these areas.

Monitoring early neuromotor performance using the Hammersmith Infant Neurological Examination to predict later cognition.

This commentary is on the original articles by Romeo et al. To view this paper visit https://doi.org/10.1111/dmcn.15191 and https://doi.org/10.1111/dmcn.15201.This commentary is also available in Chinese. To view this paper.

Tool Use for Early Detection of Cerebral Palsy: A Survey of Spanish Pediatric Physical Therapists.

The purpose of this study was to assess the use of diagnostic assessment tools in pediatric physical therapy practice in Spain. Best practice recommendations indicate the timely use of key assessment tools to reduce the age of diagnosis of cerebral palsy (CP). Pediatric physical therapists currently working in Spain in early intervention were recruited through targeted physical therapy entities. They were invited to complete the purpose-developed electronic survey, consisting of 45 multiple-choice questions, with 5 thematic blocks. Results from 140 anonymous respondents were analyzed. The average reported age when CP was suspected was 12.6 months. Most used the child's clinical history (88.1%), the Alberta Infant Motor Scale (41.3%), and Vojta Assessment Procedure (32.1%) to assess and detect CP. General Movements Assessment (25.7%) and Hammersmith Infant Neurological Examination (28.4%) were used infrequently. Currently, pediatric physical therapists in Spain rely on clinical history and outdated tools to identify children with CP.Digital Abstract available at: http://links.lww.com/PPT/A361 (English).Digital Abstract available at: http://links.lww.com/PPT/A362 (Spanish).

Hammersmith Infant Neurological Examination in low-risk infants born very preterm: a longitudinal prospective study.

To describe the profile of global and single items of the Hammersmith Infant Neurological Examination (HINE) in a population of low-risk infants born very preterm during the first year of life. The HINE was performed at 3, 6, 9, and 12months' corrected age in a population of low-risk infants born preterm with a gestational age of fewer than 32weeks and with normal or minimal changes on neuroimaging. A total of 174 infants born preterm (96 males, 78 females; mean gestational age=27weeks [SD=1.8], range 23-31weeks) fulfilled the inclusion criteria. The 10th centile cut-off score with median and range was reported for the HINE global and subsection scores. A progressive increase in global HINE scores was observed. Most of the single items, especially those related to tone, posture, and reflexes, showed progressive maturation. Our results, which provide longitudinal data for single-item and global scores in a population of low-risk infants born very preterm, can be used as a reference in both clinical and research settings to monitor early neurological signs in these infants. These data could be used as normative data when examining low-risk infants born preterm.

Turkish Validity and Reliability of the Hammersmith Infant Neurological Examination (HINE) with High-Risk Infant Group: A Preliminary Study.

Objective: The purpose of this study was to establish the reliability of the Turkish translation of the Hammersmith Infant Neurological Examination in infants at 8-12 months corrected age and compare Hammersmith Infant Neurological Examination scores to other predictive assessments.Materials and Methods: Perinatal risk factors, term-age magnetic resonance imaging, general movements at 3-month corrected age, and 12-month corrected age The Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) scores were obtained in 35 high-risk infants. The Hammersmith Infant Neurological Examination was evaluated using intra-rater and inter-rater reliability. Hammersmith Infant Neurological Examination scores were compared to the findings from the three other assessments.Results: Intra-rater and inter-rater reliability was high (intraclass correlation coefficient = 1.00; intraclass correlation coefficient = 0.969, P < .001, 95% CI = 0.939-0.984, respectively). Global Hammersmith Infant Neurological Examination scores were significantly lower in infants with magnetic resonance imaging evidence of brain injury than without (P < .05) and in infants without general movements Fidgety movements (P < .05), than with. There was a significant positive correlation between global Hammersmith Infant Neurological Examination scores and Bayley Scales-III cognitive (P < .001), language (P < .001), and motor composite scores (P < .001).Conclusion: This study strongly supports the use of the Turkish translation of the Hammersmith Infant Neurological Examination. Users found it readily understandable and easy to use, and the scores were consistent with 3 different methods of predicting neurodevelopmental outcomes. These findings will aid the early diagnosis, management, and support for children with neurodevelopmental problems.

Deep learning-based quantitative analyses of spontaneous movements and their association with early neurological development in preterm infants

This study aimed to develop quantitative assessments of spontaneous movements in high-risk preterm infants based on a deep learning algorithm. Video images of spontaneous movements were recorded in very preterm infants at the term-equivalent age. The Hammersmith Infant Neurological Examination (HINE) was performed in infants at 4 months of corrected age. Joint positional data were extracted using a pretrained pose-estimation model. Complexity and similarity indices of joint angle and angular velocity in terms of sample entropy and Pearson correlation coefficient were compared between the infants with HINE < 60 and ≥ 60. Video images of spontaneous movements were recorded in 65 preterm infants at term-equivalent age. Complexity indices of joint angles and angular velocities differed between the infants with HINE < 60 and ≥ 60 and correlated positively with HINE scores in most of the joints at the upper and lower extremities (p < 0.05). Similarity indices between each joint angle or joint angular velocity did not differ between the two groups in most of the joints at the upper and lower extremities. Quantitative assessments of spontaneous movements in preterm infants are feasible using a deep learning algorithm and sample entropy. The results indicated that complexity indices of joint movements at both the upper and lower extremities can be potential candidates for detecting developmental outcomes in preterm infants.

Hammersmith Infant Neurological Examination in infants born at term: Predicting outcomes other than cerebral palsy.

We explored the ability of the Hammersmith Infant Neurological Examination (HINE) to identify cognitive performance delay at 2years in a large cohort of infants born at term. We conducted a retrospective study of infants born at term at risk of neurodevelopmental impairments assessed using the HINE between 3 and 12months post-term age and compared them with a cohort of typically developing infants born at term. All infants performed a neurodevelopmental assessment at 2years of age using the Mental Development Index (MDI) of the Bayley Scales of Infant Development, Second Edition; the presence of cerebral palsy (CP) was also reported. The infants were classified as being cognitively normal/mildly delayed or significantly delayed (MDI<70). The predictive validity of HINE scores for significantly delayed cognitive performance, in infants with and without CP, was calculated using specific cut-off scores according to age at assessment. A total of 446 at-risk and 235 typically developing infants (345 males, 336females; mean [SD] gestational age 38.7weeks [1.4], range 37-43weeks) were included. Of the at-risk infants, 408 did not have CP at 2years; 243 had a normal/mild delayed MDI and 165 had an MDI less than 70. Of the at-risk infants, 38 developed CP. HINE scores showed a good sensitivity and specificity, mainly after 3months, for identifying significantly delayed cognitive performance in infants without CP. In those with CP, the score was associated with their cognitive performance. The comparison group had the highest HINE scores. The HINE provides evidence about the risk of delayed cognitive performance at age 2years in infants born at term with and without CP.

Reference Material for Hammersmith Infant Neurologic Examination Scores Based on Healthy, Term Infants Age 3-7 Months

To provide a valid, continuous reference interval, including a 10th percentile cut-off, for Hammersmith Infant Neurological Examination (HINE) scores based on 3- to 7-month-old term infants with weight appropriate for gestational age. In a prospective study, we examined 168 Norwegian infants at one timepoint with HINE at 3-7months of age. In 134 of these infants Ages and Stages Questionnaire was completed by their parents at 2years of age to ensure typical motor development. We calculated a reference interval for HINE scores with the 10th percentile as cut-off for age-dependent optimal scores. The best fitting mean model for HINE total score was 78.1358+9659.231∗1/age in weeks2-5104.174∗natural logarithm(age in weeks)/age in weeks2, which explained 49.8% of the variance. The HINE total score 10th percentile cut-off corresponded to 52.1 points at age 12weeks, 55.6 points at 16weeks, 59.0 points at 20weeks, 61.8 points at 24weeks, and 63.8 points at 28weeks. We found an excellent intraclass correlation coefficient of 0.953 (0.931-0.968) between 2 examiners. The infants had a typical motor development at 2years follow-up. We have presented a valid, continuous reference interval and a 10th percentile cut-off for HINE scores for infants age 3-7months.

Early detection of Australian Aboriginal and Torres Strait Islander infants at high risk of adverse neurodevelopmental outcomes at 12 months corrected age: LEAP-CP prospective cohort study protocol

IntroductionNeurodevelopmental disorders (NDD), including cerebral palsy (CP), autism spectrum disorder (ASD) and foetal alcohol spectrum disorder (FASD), are characterised by impaired development of the early central nervous system, impacting cognitive...

Early Neurodevelopmental Outcome of Asphyxiated Newborns Treated with Therapeutic Hypothermia: A Non Randomised Cohort Study

Introduction: Therapeutic Hypothermia (TH) is now a proven model of treatment to prevent complications in asphyxiated newborns. Perinatal asphyxia is the leading cause of mortality and disability in India and developing countries. The TH is still not the standard treatment protocol in developing India, and data regarding early neurological outcomes after TH is lacking. Aim: To evaluate the early neurological outcome at 3, 6, and 9 months of asphyxiated newborns who received TH compared to non recipients. Materials and Methods: This was a non randomised cohort study conducted at the tertiary care teaching hospital. A total of 190 asphyxiated newborns admitted to Neonatal Intensive Care Unit (NICU) within 24 hours of life, meeting the laboratory and/ or clinical criteria of perinatal asphyxia were enrolled. Eligible newborns admitted within 6 hours of birth receiving TH were labelled as recipients, and those who received standard care were labelled as non-recipients. Neonates were assessed at 3, 6, and 9 months and compared for neurodevelopment using the Hammersmith Infant Neurological Examination (HINE) optimality score and Denver Developmental Screening Test II. Both groups were compared using t-test and chi-square test. Results: Out of the total 190 enrolled participants, 14 were excluded and 176 newborns were further divided into recipients and non recipients groups. Baseline demographic characters were similar in both groups. Seventy-five recipients were followed up till three months, 72 at six months, and 69 at nine months vs 62, 60, and 56 non recipients, respectively. Lesser number of recipients scored suboptimal scores (HINE score &lt;67) at 3 months vs non recipients (20% vs 35.4%, mean/ SD 63 [3.43] vs 57 [4.55], [p&lt;0.001]). At six months (HINE score&lt;70), the incidence was 18% vs 21% (p=0.02), mean score 67 vs 61 (p&lt;0.0001); and at 9 months (HINE score&lt;73) the incidence was 14.4% vs 30.3% (p=0.048), mean score 72 vs 65 among recipient vs non recipients (p&lt;0.0001). Recipients also had less incidence of severe disability (HINE score&lt; 40) at 6 (8.3%vs 21.6% p&lt;0.02), and 9 months (8.3% vs. 19.6%, p&lt;0.04) as compared to non recipients. More recipients had a normal developmental screening at 3,6, and 9 months on the DDST scale. Recipients required fewer anti-epileptics at 3 and 6 months (3 vs 11) as compared to non recipients (p&lt;0.05). Mortality was also less in recipients (7.8% vs 20.9%, p&lt;0.05) as compared to non recipients. Conclusion: There was a significant developmental and neurological improvement with decreased mortality, less episode of seizures, reduction in the need for antiepileptic among recipients of TH compared to non recipients at 3, 6, and 9 months of age.

Predictive Value of the Test of Infant Motor Performance and the Hammersmith Infant Neurological Examination for Cerebral Palsy in Infants

Predictive Value of the Test of Infant Motor Performance and the Hammersmith Infant Neurological Examination for Cerebral Palsy in Infants

General movements assessment, part II: the use of general movement assessment as a predictive tool of cerebral palsy – a scoping review

The diagnosis of cerebral palsy is usually made between the 12 and 24 months of age which often delays the implementation of early therapeutic intervention. General movements assessment is one of the tools for the early diagnosis of cerebral palsy. The aim of this study was to present the current knowledge on the use of the general movements assessment in predicting cerebral palsy. The literature review was made in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. The PubMed medical database was searched, 24 publications were identified and included in the detailed analysis. The highest sensitivity was demonstrated for the general movements assessment performed during the fidgety period and in preterm infants. General movements assessment and/or Hammersmith Infant Neurological Examination (HINE) are recommended as a routine screening of newborns with documented risk factors for cerebral for the earliest possible diagnosis. Raising the awareness of medical personnel should be of key importance for the implementation of the recommended procedure.

Profile of minor neurological findings after perinatal asphyxia.

AimTo characterise the spectrum of findings in sequential neurological examinations, general movements (GM) assessment and magnetic resonance imaging (MRI) of infants with perinatal asphyxia.MethodsThe prospective cohort study of term infants with perinatal asphyxia treated at Helsinki University Hospital's neonatal units in 2016–2020 used Hammersmith Neonatal Neurological Examination (HNNE) and brain MRI at 2 weeks and Hammersmith Infant Neurological Examination (HINE) and GM assessment at 3 months of age.ResultsAnalysis included 50 infants: 33 displaying perinatal asphyxia without hypoxic‐ischaemic encephalopathy (HIE), seven with HIE1 and 10 with HIE2. Of the infants with atypical HNNE findings, 24/25 perinatal asphyxia without HIE cases, 5/6 HIE1 cases and all 10 HIE2 cases showed atypical findings in the HINE. The HINE identified atypical spontaneous movements significantly more often in infants with white matter T2 hyperintensity.ConclusionIn this cohort, most infants with perinatal asphyxia, with or without HIE, presented atypical neurological findings in sequential examinations. The profile of neurological findings for children with perinatal asphyxia without HIE resembled that of children with HIE. White matter T2 hyperintensity was associated with atypical spontaneous movements in the HINE and was a frequent MRI finding also in perinatal asphyxia without HIE.