Evaluation of the Neonatal Neurobehavioural Assessment (Neo-NBA): a Novel Tool for Early Identification of Neonates at Risk of Neurodevelopment Impairments

Background: Neurodevelopmental impairments (NDIs) are a range of conditions affecting different areas of functioning which usually present in infancy and childhood and can have long-lasting impact. Their prevalence varies depending on geographical location, with the highest rates in middle- and low-income countries (LMICs). In order to improve the wellbeing of affected infants a timely diagnosis is necessary but not always possible, especially in low-resource settings. Neonatal neurological assessments are useful instruments for identifying infants at risk of NDIs, but their use is limited in LMICs. In order to fill this gap, the Neonatal Neurobehavioural Assessment (Neo-NBA) has been developed by the Intergrowth-21st Consortium as a new standardized and comprehensive screening tool. It is a new neuropsychomotor and neuro-bio-behavioural assessment, easy to learn and to use, quick, accessible, cheap and feasible to be performed also by non-specialized personnel, especially in LMICs. Objective: this study focuses on the implementation in clinical practice of the Neo-NBA across different settings. It aims to evaluate its validity and performance in a population of term and moderate-to-late-preterm infants and to compare it to the Hammersmith Neonatal Neurological Examination (HNNE), to evaluate their agreement and the Neo-NBA’s the sensitivity and specificity in predicting thresholds of risk of the HNNE. Methods: this is a prospective observational study, conducted in the Neonatal Department of the University of Turin-affiliated S. Anna Hospital. It enrolled n=53 term and n=28 moderate-to-late-preterm infants, on which the Neo-NBA and the HNNE were performed. Mean scores and standard deviations (SD) for each domain of the Neo-NBA were obtained and compared among the two groups. Concurrent validity between Neo-NBA and HNNE scores was evaluated by analysing the distribution of both scores in the study population. ROC curve analysis was conducted to determine the Neo-NBA score cutoff that best predicted the HNNE optimality cutoff. Results: Results demonstrated good sensitivity of the Neo-NBA in distinguishing between term and moderate-to-late-preterm infants, aligning with existing literature that shows preterm infants have poorer neurological scores, particularly in tone and overall neurological performance. A strong agreement between the Neo-NBA and HNNE was established, confirming the validity of the Neo-NBA, despite its simpler administration and the absence of the need for specialized training. Furthermore, ROC curve analysis identified a cut-off score of 88.5 for the Neo-NBA, with a sensitivity of 91% and specificity of 51% in predicting suboptimal HNNE scores, demonstrating its effectiveness in identifying “at-risk” infants for further evaluation. Conclusion: Given its ease of use, cost-effectiveness, suitability for non-specialized personnel and demonstrated validity the Neo-NBA holds great potential for widespread implementation in LMICs, offering an accessible tool for early detection of NDIs and early intervention. This can significantly impact the long-term outcomes of affected infants and reduce the healthcare burden in resource-limited settings.