Neonatal Motor Pattern automatIc Analysis

Neonatal Care and Newborn Examination:

Every newborn undergoes a comprehensive clinical examination in the delivery room before being transferred to the postpartum ward with their mother (decree of October 18, 1994). At least one additional full examination is conducted during the maternity stay. Mandatory before the 8th day of life, this examination is recorded in the health booklet and allows for the issuance of the first health certificate (8th day certificate). It is performed in the presence of the mother or both parents, in a well-lit, adequately heated room, preferably before a meal or during a care routine, when the child is alert, and following hygiene rules (handwashing, use of a dedicated gown for the newborn, and disinfection of equipment). Significant clinical variations are possible among newborns, and a number of minor anomalies may be detected.

The neurological assessment of the newborn begins with gathering maximum information about prenatal history and birth context. Family and social backgrounds are also crucial. For instance, previous neonatal deaths in the family may indicate autosomal recessive metabolic disorders, while details of any previous maternal miscarriage are particularly relevant in suspected X-linked dominant disorders, where male lethality is common. Medical records are extremely useful sources for Apgar scores, blood gas results, antepartum monitoring data, and any obstetric complications. Clinical information regarding the immediate postpartum period, known as the "golden hour" in high-risk groups, can also be very valuable. Additionally, nurse observations, when available, are generally invaluable. When evaluating newborns with paroxysmal disorders, video sequences of the events in question can provide valuable diagnostic clues.

Clinical examination remains a central element and perhaps the most cost-effective and safest tool for evaluating newborns suspected of having a neurological problem ("Wusthoff CJ. How to use: the neonatal neurological examination. Arch Dis Child Educ Pract Ed. 2013;98:148-53." Extract from: Mustafa A. M. Salih. "Clinical Child Neurology." iBooks.). Thus, the main objectives of the examination are to determine whether the newborn is "neurologically normal" or not and to initiate further investigations if necessary. It also serves to assess the worsening (or improvement) of the newborn's condition over time. It should be noted that the newborn's neurological status often cannot be fully determined by a single neurological examination, especially if it is performed quite early. In fact, the predictive value of the neurological examination tends to improve with the newborn's chronological age, as illustrated by the case of a newborn who suffered significant hypoxic-ischemic injury at birth, for example. Indeed, this child's clinical presentation will vary over time, and a complete and accurate assessment of lesions is often possible remotely. Furthermore, it is well known that the newborn's neurological status can be affected by a range of "non-neurological" factors such as medications administered to the mother during pregnancy, infections, respiratory disorders, and unpleasant stimuli such as pain (from the cold hand of an examiner, for example) and hunger.

Description of the Research Focus There are several standardized and validated scales and approaches widely used in various neonatal units. Each has its strengths and weaknesses, but they are all comprehensive enough to provide an idea of the neurodevelopmental profile of both full-term and premature newborns. Many of them, such as the Dubowitz examination, are freely accessible on the internet and in most neonatology manuals.