Reply to the letter to “Cultural adaptation and reliability assessment of the Hammersmith neonatal neurological examination for Brazilian newborns at risk of cerebral palsy”

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Dear Editors,

Please find the answers to the questions below.

Answer: We sent a letter to the Journal explaining the alterations and inserted the modifications in the paper. Both are attached.

Answer: We have included this information in the paper. We attached the paper with the alterations and sent it to the journal.

Answer: We have included this information in the paper. We attached the paper with the alterations and sent it to the journal.

Answer: We have included this information in the paper. We attached the paper with the alterations and sent it to the journal.

Answer: We have included this information in the paper. We attached the paper with the alterations and sent it to the journal.

Answer: We include in the paper the information “respecting corrected age for application in preterm babies”.

Answer: According to the process you have followed, our translation and cross-adaptation were carried out with all the scientific rigor necessary for the instrument to be used in our population. There was no free translation. In addition, the translation published on the Mac Keith website was published after your team authorized our research and was only made available on the site when we were finalizing the whole process. Your team already had access to our translation when this happened since the translation was the first stage of development.

Answer: Most assessment instruments were developed in countries of the global North and have been misused in countries of the global South due to a lack of cultural equivalence in sociocultural realities that differ from their origin. This factor interferes with the designation of results in different ethnocultural realities. 3 It is well documented in scientific studies that the different clinical manifestations, evolutions, and prognoses are interdependent on the culture in which the subjects are inserted. It is, therefore, essential to standardize an instrument to establish a common language among professionals and researchers and to draw up a worldwide overview of ethnocultural variations and sociocultural factors to the detriment of different regions. 3 Here in Brazil, we have organized the process of cross-cultural adaptation to follow scientific criteria. To this end, before starting our research, we asked the authors of the HNNE and HINE for authorization for this process, and we received this authorization before starting all the stages, as proof sent by email to the journal.

Answer: In this case, the psychometric analysis was carried out to confirm that the cross-culturally adapted version maintained the same reliability as the original version, i.e., the reliability of measuring precisely, consistently, and stably what is proposed and with a high degree of agreement between multiple measures of the same object. Psychometric validation consists of evaluating the reliability and validity measures of the instrument. Reliability is obtained by internal consistency (measured by Cronbach's alpha coefficient) and reproducibility (measured by test and retest). 4 5

We would like to inform you that this research is part of a larger research project called “Translation, cross-cultural adaptation, and validation of the Hammersmith Infant Neurological Assessment (HINE) instrument for Brazilian infants at risk of cerebral palsy” ( * Tradução, adaptação transcultural e validação do instrumento Hammersmith Infant Neurological Assessment (HINE) para lactentes brasileiros com risco de paralisia cerebral 6* ), developed in the PhD program of the Postgraduate Program in Neurology of the Faculdade de Medicina de Ribeirão Preto Universidade de São Paulo. We received the authorization of Dr. Eugenio Mercuri to proceed with this cross-adaptation, and for this research's development, the ethics committee analyzed and approved the project under opinion no. 1.809.858. This thesis was analyzed and approved by three doctoral researchers, and the manuscript was analyzed by two blind reviewers and was approved.