Hammersmith Neonatal Neurological Examination (HNNE)

The Hammersmith Neonatal Neurological Examination is a structured way of examining a newborn's nervous system. It was built so that findings could be recorded consistently, making it possible to compare one baby with another or the same baby over time.

Thirty-four items sit in six categories: posture and tone, tone patterns, reflexes, spontaneous movements, abnormal neurological signs, and orientation and behaviour. Each item is a row on a single-page form with five columns describing possible responses; the examiner circles the column that matches what the baby did. Scores can then be converted into optimality scores, which compare each finding against what is typical for healthy term newborns rather than simply summing raw values.

Licensing Notes: Mac Keith Press hosts the proformas and instructions, which are freely available; teaching videos showing how to perform and score the examination require registration and a subscription, restricted to health professional trainees and practitioners. No formal training or certification is required — the examination can be self-taught through the Mac Keith site.

Learn More: Optimality scores are what make the HNNE interpretable, and they are population-specific. A total of 30.5 or higher is considered optimal for infants born at term, while 26 or higher is the threshold for preterm infants assessed at term-equivalent age.