Methodological issues on interrater reliability of the modified Sarnat examination in preterm infants

Dear Editor,

We carefully read the influential article by Pavageau and colleagues published in the journal Pediatric Research in 2019.¹ To determine the reliability of the modified Sarnat neurologic examination in late and moderately preterm neonates born at 32–36 weeks’ gestational age was the purpose of this study. Kappa values were used to evaluate and analyze the agreement between examiners.¹ Based on the results, the reliability of the neurologic exam between the gold standard (GS) study investigator and groups of attending neonatologists was good to excellent (k > 0.72) in most categories except for Moro and tone. While the agreement was poor/fair for both tone and Moro categories in infants born at 32–34 weeks’ gestation (k = 0.20–0.60), at 35–36 weeks’ gestation, in contrast, the agreement was perfect for the tone and Moro categories (k = 1.0). However, when the GS examiner was compared to groups of attending examiners, the agreement in the Moro and tone categories was fair, k = 0.46.¹

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