Why Is the Neurological Examination So Badly Neglected in Early Childhood?

To the Editor.—

We read with interest 2 articles concerning neonatal neuropathophysiology in the February issue of Pediatrics. The first article, “Abnormal Cerebral Structure Is Present at Term in Premature Infants” by Inder et al¹ (co-authored by Joseph J. Volpe), presents important new findings by the authors, who used advanced MRI techniques to document impaired cerebral development present at term equivalent in very low birth weight premature infants. They correlated advanced 3-dimensional reconstruction MRI images with “physical examination by an experienced neurologist or neonatologist and/or a developmental examination based on observational data from parent report and examination with the Denver Developmental Screening tool.”¹ This shocking lack of rigor for the clinical assessment contrasts sharply with the extreme sophistication on …