The neurological examination in the critically unwell newborn infant: a new proforma to aid practice and interpretation
The neurological examination in the critically unwell newborn infant: a new proforma to aid practice and interpretation
Background: previous work has shown pediatricians the neurological examination in newborn infants because they do not feel confident performing it. In a UK survey about the neurological examination in unwell newborns, 72% wanted a proforma to aid practice. Our aim was to develop a proforma to improve the neonatal neurological examination, alongside a flowchart to aid formulation of differential diagnoses and investigation plans.
Methods: four perinatal neurologists and a graphic designer developed a proforma based on existing examinations and data on attitudes toward the examination in the unwell newborn. This was reviewed via qualitative focus groups and interviews with UK health professionals. Thematic analysis was used to gauge attitudes toward and improve the proforma.
Results: two themes arose from the review and interviews: “Neurophobia” about the neurological assessment of the acutely unwell newborn, and ways of improving practice and confidence. Participants suggested improvements to the proforma. They reported it would allow the neurological examination to be performed consistently, and it would improve confidence, documentation, communication, and interpretation of findings.
Conclusions: we have developed a proforma for documenting the neurological assessment of the unwell newborn, which participants report will improve reliable identification of abnormal signs, their neuroanatomical siting and significance, and confidence in assessing an unwell newborn neurologically. The proforma is not intended to replace current examinations for the stable term or preterm newborn, for whom appropriate validated tools should be chosen. We plan to undertake further validity testing, including interobserver agreement and data on the value of the interpretive flowchart.
Diagnosis, Infant, Intensive care, Neonatal, Neurological examination, Newborn, Physical examination
19-27
Hart, Anthony R.
b6af99e6-9d60-4c8d-b8a2-4537a15af76d
Rao, Anusha
88a3e759-ac1f-4b46-b41b-db734c62aba5
Moat, Daniel
1088b763-20af-4722-85fc-aeac430016d1
Williams, Tamanna
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Cowan, Frances M.
442f93bd-1b14-4ab9-82ae-3885a3228959
30 January 2026
Hart, Anthony R.
b6af99e6-9d60-4c8d-b8a2-4537a15af76d
Rao, Anusha
88a3e759-ac1f-4b46-b41b-db734c62aba5
Moat, Daniel
1088b763-20af-4722-85fc-aeac430016d1
Williams, Tamanna
24653916-6234-497e-afc7-fdf5d438af87
Cowan, Frances M.
442f93bd-1b14-4ab9-82ae-3885a3228959
Hart, Anthony R., Rao, Anusha, Moat, Daniel, Williams, Tamanna, Cowan, Frances M. and Vollmer, Brigitte
(2026)
The neurological examination in the critically unwell newborn infant: a new proforma to aid practice and interpretation.
Pediatric Neurology, 177, .
(doi:10.1016/j.pediatrneurol.2026.01.008).
Abstract
Background: previous work has shown pediatricians the neurological examination in newborn infants because they do not feel confident performing it. In a UK survey about the neurological examination in unwell newborns, 72% wanted a proforma to aid practice. Our aim was to develop a proforma to improve the neonatal neurological examination, alongside a flowchart to aid formulation of differential diagnoses and investigation plans.
Methods: four perinatal neurologists and a graphic designer developed a proforma based on existing examinations and data on attitudes toward the examination in the unwell newborn. This was reviewed via qualitative focus groups and interviews with UK health professionals. Thematic analysis was used to gauge attitudes toward and improve the proforma.
Results: two themes arose from the review and interviews: “Neurophobia” about the neurological assessment of the acutely unwell newborn, and ways of improving practice and confidence. Participants suggested improvements to the proforma. They reported it would allow the neurological examination to be performed consistently, and it would improve confidence, documentation, communication, and interpretation of findings.
Conclusions: we have developed a proforma for documenting the neurological assessment of the unwell newborn, which participants report will improve reliable identification of abnormal signs, their neuroanatomical siting and significance, and confidence in assessing an unwell newborn neurologically. The proforma is not intended to replace current examinations for the stable term or preterm newborn, for whom appropriate validated tools should be chosen. We plan to undertake further validity testing, including interobserver agreement and data on the value of the interpretive flowchart.
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Accepted/In Press date: 11 January 2026
e-pub ahead of print date: 14 January 2026
Published date: 30 January 2026
Keywords:
Diagnosis, Infant, Intensive care, Neonatal, Neurological examination, Newborn, Physical examination
Identifiers
Local EPrints ID: 510211
URI: http://eprints.soton.ac.uk/id/eprint/510211
ISSN: 0887-8994
PURE UUID: d2015416-3d85-43a2-a0b3-84cd103a4a41
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Date deposited: 23 Mar 2026 17:35
Last modified: 23 Mar 2026 18:30
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Contributors
Author:
Anthony R. Hart
Author:
Anusha Rao
Author:
Daniel Moat
Author:
Tamanna Williams
Author:
Frances M. Cowan
Author:
Brigitte Vollmer
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