Neonatal Neuro Exam Guide

Performing a comprehensive neonatal neurologic exam requires careful consideration of several factors, as highlighted by Dr. Susy Jeng. This guide will break down the essential components and techniques to ensure accurate and thorough evaluations of neonates.

Key Preliminary Considerations

• Gestational Age: Knowing whether the infant is full-term or pre-term is crucial. This information sets the baseline for what is considered normal and abnormal in the neurologic exam.

• State Dependency: The infant's state—awake, asleep, or in active sleep—significantly affects the exam results. For example, post-feeding sleepiness can make the infant difficult to arouse.
   

Comprehensive Neurologic Exam Components

1. Mental Status

• Stimulation Techniques: Gently stimulating the infant by placing a hand on the abdomen or chest can help in assessing alertness. A full-term infant typically has flexed arms and legs at rest.

• As the infant awakens, look for increased movement and eye-opening.
   

2. Cranial Nerve Function

• Cranial Nerves 2, 3, 4, 6: Check eye movements by gently turning the infant's head and observing the doll's eye reflex.
• Cranial Nerve 5: Assess facial sensation using the rooting reflex.
• Cranial Nerve 12: Check the tongue movements as part of the rooting reflex.
• Cranial Nerve 11: Assess head-turning abilities.
• Cranial Nerves 5, 9, 10, 12: Evaluate sucking reflex by placing a finger in the infant’s mouth and noting the sucking response.
   

3. Muscle Tone

• Resting vs. Active Tone: Assess both when the infant is relaxed and when stimulated.
• Central vs. Peripheral Tone: Check the tone in the trunk and neck (central) versus the arms and legs (peripheral). Ensure the head is midline to avoid asymmetric tone.
• Suspension Tests: Vertical and horizontal suspension tests help assess central tone.
   

4. Strength

• Anti-Gravity Movements: Observe if the infant can hold their arms and legs against gravity.
• Resistance: Evaluate the resistance when trying to straighten the infant's limbs.
   

5. Sensory Response

• Light Touch: Check for responses to light touches and slight tickles.
  
  
• Pressure Response: If needed, apply gentle pressure to see if the infant localizes to the stimulus.
   

6. Reflexes

• Deep Tendon Reflexes: Use appropriate-sized reflex hammers to assess reflexes in the arms and legs, including bicep, tricep, patella, and Achilles reflexes.
  
  
• Primitive Reflexes: Evaluate the presence of reflexes such as the asymmetric tonic neck reflex, Moro reflex, hand and plantar grasps, stepping reflex, and the Galant reflex.