Interpreting Early Neurological Findings in Infants with Gastroesophageal Reflux Symptoms: A Longitudinal Evaluation Using the HINE

Background: Gastroesophageal reflux (GER) is common during infancy. Transient neuromotor features, including alteration in muscle tone, posture, and motor behaviour, have been observed in infants with GER symptoms. Methods: This retrospective observational study included 55 infants with clinical symptoms of GER, including 43 preterm and 12 term-born infants, evaluated at 3, 6, and 9 months (chronological or corrected age for preterms) using the Hammersmith Infant Neurological Examination (HINE). General Movements Assessment (GMA) and motor milestones were used as outcome indicators. Preterm cases were compared with 141 low-risk preterm controls. Linear Mixed-Effects Models (LMMs) with Bonferroni correction evaluated longitudinal Movements trajectories, while term-born infants were analyzed descriptively. Results: Global HINE scores progressively increased (3 months: 53.66 ± 5.75; 9 months: 68.35 ± 5.65), with no significant differences between preterm infants with GER symptoms and low-risk preterm controls. Conversely, the Movements subscale was consistently lower in the GER group at 3 (p = 0.001), 6 (p = 0.001), and 9 months (p < 0.001). LMM confirmed a significant association between GER symptoms and lower Movements scores (F = 47.405, p < 0.001; adjusted difference = −1.167), with a non-significant Group × Time interaction (p = 0.251), indicating no statistically significant evidence of different longitudinal trajectories. Bonferroni correction (α = 0.010) confirmed Movements as the only consistently reduced domain (padj < 0.005). Individual HINE items showed early discordance between axial and appendicular findings, followed by progressive neurological maturation. Conclusions: GER symptoms were associated with lower HINE Movements scores during the first 9 months, whereas standardized tone scores and global HINE profiles remained broadly comparable to low-risk controls. Subtle motor, tone, and postural findings observed during qualitative clinical examination should therefore be interpreted cautiously and within the broader neurological context, rather than considered in isolation. As an exploratory finding, GER symptoms may represent a relevant contextual factor when interpreting early neurological findings. Standardized examination tools like the HINE should be interpreted alongside qualitative clinical impressions and spontaneous movement quality during serial longitudinal assessments. These preliminary findings require confirmation in larger, prospective studies before their broader clinical implications can be established.