The HINE is a neurological exam which will show the signs typical of cerebral palsy (CP). However, to make that diagnosis the signs have to be interpreted in the light of the history, mode of presentation and preferably brain imaging findings (see diagnostic criteria for CP here). Whilst cerebral palsy is the commonest single cause of neurological abnormality in young children it is extremely important to think about and to rule out other conditions e.g. genetic, metabolic, or neuromuscular disorders that may lead to neurological abnormality.
In the context of cerebral palsy the scores from the HINE after 5-6 months can be used to predict the later ability to sit and walk. In general, the lower the scores the more severe the impairment and cerebral palsy. Scores for children with milder hemiplegia may be in the normal range but the number of asymmetries are important in making this diagnosis. An asymmetry score developed by Hay et al 2018 helps with this diagnosis but please note that the asymmetry data presented was relatively late (median 15 months).
The test items in the two printed versions are exactly the same. One version (the earlier one from Dubowitz L et at J Pediatrics 1998;133:406-416 ) gives information on how to perform each of the different items on the left hand side of the page; it is better to use this version when you are starting out as you have a guide in front of you on how to carry out the exam. The other version from the later paper by Ricci et al (2008) does not give this information but on the right hand side of the page gives data relating to the normal ranges of findings for newborn term infants and also for infants born at different gestational ages when they reach term equivalent age. This version is more helpful when assessing whether the infant you are examining is performing within the normal range.
Yes, the exam and proforma can be used for recording the neurological findings at any age in infants of all gestational ages and also for recording sequential changes in neurological development. But there are no standardised normative data prior to 34 weeks gestational age to allow a strict description of normality for all combinations of gestation and post-natal ages, or scoring for the purposes of prediction of outcome.
Normative data for infants at term equivalent age are included in one of the proformas in the Proformas section. For infants born at 34-36 weeks gestation and examined in the first few postnatal days, normative data can be obtained from the article by Romeo et al.
If you are undertaking a research project, then those responsible for the study need to decide on a consistent approach to missing items. It is possible to estimate a score allowing for missing items, but we recommend this should not be more than 5 items – after that it is better to exclude the case.
In a clinical context clearly doing this might lead to worrying clinical interpretation e.g. if the child did not fix or follow or suck feed – these are highly significant findings in themselves and calculating an overall score would not be helpful or in the child’s interest. However, usually one missing item will not be crucial for deciding whether a child needs further follow-up or not, but it is always important to look at the overall pattern of findings and the clinical issues, not just the score. We encourage checking that the proforma is complete before the child leaves the clinic.
HNNE: This depends on whether you are dealing with an acute situation or a clinical visit. With an infant who is acutely ill the condition is changing rapidly and a daily exam would be needed. Similar advice applies to an infant who suddenly deteriorates. An exam shortly before discharge from the hospital and at term age when there is most normal data to compare is very useful.
HINE: On first review at around 3 months (or on referral) and on subsequent clinic visits – there is comparative normative data at 3, 6, 9, 12 and 18 months. The recording proforma can be used at any time – you do not need to wait for these standardised times.
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