Table 3.

Clinically significant results of NNNS exam for the case infant at 1 month of age.

Abnormal findings in case NNNS exam	Neurobehavioral symptoms
Displayed hypertonicity in trunk, neck, and upper/lower extremities		Excessive or above-normal muscle tone or tension; the infant’s musculature becomes “stiff” or rigid, and the infant shows marked resistance to passive movements.
Setting sun sign observed during first third of examination		Eyes point downward, pupils partially covered by lower eyelids, and sclera visible above the pupils.
Low-frequency/high-amplitude tremors and high-frequency/low-amplitude tremors		Tremors are rapid, rhythmic oscillation movements with a segmented quality.
Cogwheel movements		Movements are slower, coglike, jerky.
Athetoid posture of fingers observed at beginning of examination		Some of the fingers are fully flexed while others are simultaneously extended, simultaneous flexion of the elbow and rotation of the upper limb, or extension at the elbow with rotation of the wrist. Athetoid movements are slow, writhing changes from one athetoid posture to another.
High-pitch cry		Infant’s cry is high pitched at any time during the examination when the infant is in a sustained crying state.
Extreme irritability		Infant fusses or cries throughout the examination. The fuss/cry seems to be insulated in the sense that is seems to control the infant and determines the flow of the exam. This is the infant who is “at the mercy” of his or her fussiness. Crying is persistent and excessive. The infant cries to minimal as well as vigorous handling and maybe even without stimulation.