Objective: To assess the interobserver reliability of the neurological optimality score.
Study design: The neurological optimality score of 21 full term healthy, neurologically normal newborn infants was determined by two well trained observers.
Results: The interclass correlation coefficient was 0.31. Kappa for optimality (score of 58 or higher) was 0.19. A systematic difference of 1.3 points between the two observers was present.
Conclusions: The interobserver variability of the neurological optimality score of the newborn infant is substantial. The subtle judgement of elicited responses as optimal or non-optimal proved to be especially critical in this concordance study. A difference of at least two points in the score is considered as a valid endpoint for comparative studies. If two or more observers are involved in the neurological examination of the newborn infant in a study to assess influences on perinatal morbidity, frequent re-instruction sessions are recommended.