Ingrid Bjerre

Cause and Effect of Obstetric (Neonatal) Brachial Plexus Palsy

ABSTRACT. We have studied the causes and outcome of obstetric brachial plexus palsy in all children born in Malmö during the 10‐year period 1973–1982. Forty‐eight of 25736 live‐bom children (0.19%) were neonatally diagnosed as having a brachial plexus paresis. Twenty‐five percent of these, i.e., one child in 2000 liveborn, had a persistent palsy. The obstetric history was characterized by high birthweight, vertex presentation with shoulder dystocia and multiparity; and in two cases the mother had two children with brachial palsy. The children who recovered totally did so during the first few months. The prognosis for the more common upper brachial plexus, or Erbs, was more favorable than that for entire brachial plexus palsy. All the children with persistent palsy were afflicted with considerable reduction in arm function, resulting in varying degrees of handicap, such as not being able to use the palsied arm at all or not being able to perform certain tasks—writing properly, playing a musical instrument, doing the hair, wearing clothing with shoulder straps, etc. We wish to point out that, in several cases, obstetric brachial plexus palsy results in a lifelong handicap and that prevention and therapy are essential both in obstetric and in pediatric management.

Monitoring of cerebral function after severe asphyxia in infancy.

Thirty nine infants with severe asphyxia (28 affected perinatally and 11 later) were studied by electrophysiological cerebral function monitoring (CFM) for periods varying from a half to 49 days. Nineteen infants died while still in intensive care and two died later from sequelae. Eighteen survived and were followed up when aged between 8 and 36 months. The initial electroencephalogram (EEG) and the first 12 hours of CFM tracing correlated well. The type of background activity, whether continuous or interrupted, proved to be of high prognostic importance unlike the presence of seizure activity, which bore no distinct correlation to outcome in these severely asphyxiated infants.

BENIGN FAMILIAL NEONATAL CONVULSIONS

A family is reported where during the neonatal period convulsions have appeared in not less than 14 members in five generations. It appears to be an autosomal dominant trait. The disorder is benign and the convulsions have disappeared in the first weeks with a few exceptions, where sporadic convulsions have appeared up to 10 years of age. The etiology is at present unknown and there are no signs of disturbance in electrolyte or sugar balance or in amino‐acid metabolism.

Neurological assessment of preterm infants at term conceptional age in comparison with normal full-term infants

In a long-term prospective study 46 unselected infants born before 35 weeks of gestational age were followed up, which included repeated neurological and psychological examination. 40 of them were neurologically evaluated at term conceptional age and compared with 26 full-term newborns, all the infants being considered healthy. There was no difference in mean weight or length between the two groups, but mean head circumference was greater in the preterm group. The preterm infants had lower muscle tone as judged by spontaneous posture of arms and legs, and poor resistance to passive movements and slow arm recoil. In the traction test they had more head lag. The withdrawal and Moro reflexes were weaker, while asymmetric tonic neck reflex (ATNR) was easier to elicit. Head control in the sitting position was better. All infants were evaluated with a prenatal and perinatal optimality score, which was not however significantly correlated with the neurological findings. The preterm infants with only slightly reduced optimality score (low risk group) had approximately the same birth weight and gestational age as the other preterms. They more resembled the full-term infants with good resistance to passive movements, fast arm recoil and good responses concerning the withdrawal and Moro reflexes. However, they had a semiflexed position in supine and thus in this respect were more like the other preterms.

PSYCHOMOTOR DEVELOPMENT AND SCHOOL-ADJUSTMENT OF 7-YEAR-OLD CHILDREN WITH LOW BIRTHWEIGHT

Abstract. 144 children with low birthweight (2 500 g, LBW) were studied at 7 years of age by questionnaires filled in by their parents and teachers. The children had attended school for at least 3 months at the beginning of the investigation. The teachers also filled in questionnaires regarding 144 sex‐and age‐matched children who served as controls. The questions included performance at school, motor function, and attitude to school‐mates and to adults. The distribution of the LBW‐children among different types of schools was compared with that of the general population. The intellectual level was estimated from Goodenoughs Draw‐a‐man‐test. Seven LBW‐children attended special classes, and this was more than expected in the general population. On the average, the intellectual level of LBW‐children was lower than that of the controls. The difference was due mainly to children with a birthweight s2 000 g. Regarding motor function, the LBW‐children were not quite as capable as the controls. They got on less well with their school‐mates and were more anxious, shy and dependent. Many of the parents were overprotective. The differences between the LBW‐children and the controls were subtle. Neurological status at 5 years of age was not clearly related to school performance and school‐adjustment. Socioeconomic factors played no obvious role in this study.

Follow-up of preterm children. I. Neurological assessment at 4 years of age.

In a long-term prospective study, 46 unselected infants born before 35 completed weeks of gestational age were compared with 26 full-term infants. At 4 years of age, 44 preterms and 25 full-terms were available to follow-up. Two preterm children manifested abnormal neurological development, slight spastic diplegia in one case, and psychomotor retardation in the other. Both these cases had already been identified at 18 months of age. Thorough neurological assessment revealed a number of differences between the two groups indicating both delayed neurological maturation and mild dysfunction in the preterms. We drew up a neurological profile to describe these minor neurological signs. The preterms had poorer muscle tone, more spontaneous movements, and were less skilled in certain gross motor functions. They also showed less developed balance reactions, had difficulties in some coordination tests, and asymmetry was more common in neurological functions. In the different subsystems of the neurological profile we also found a greater variation in the preterm group than in the full-term group. There were no significant correlations within the preterm group between the neurological findings at 4 years of age and gestational age, birthweight, and prenatal or perinatal factors.

Growth and development in preterm infants during the first 18 months

In a long-term prospective study 46 unselected infants born before 35 completed weeks of gestational age were followed up, and compared to 26 fullterm infants. At 9 and 18 months of chronological age their height and weight were still lower than that of fullterms, but the difference disappeared when age was corrected for gestational age at birth. The motor and neurological maturity and language development was delayed in the preterms still at 18 months, which could possibly also be explained by their lower biological age. Ten of the preterm infants showed, at one or several occasions during follow up, definite neurological abnormality. At 18 months of age two of them were handicapped, one with retrolental fibroplasia, nearly blind, and another with cerebral palsy (slight spastic diplegia). Five of them had late psychomotor development, while two were borderline and one normal. We defined pre- and perinatal risk groups, but found that development at 18 months was not correlated to degree of risk. Neither was there any correlation between neurological examination at term and later handicap or psychomotor retardation. We found more illness, mostly due to common infections, during the first 18 months in the preterm group, as measured by the number of visits to a doctor and days spent in hospital.

The Angelman or “Happy Puppet” Syndrome: Clinical and Electroencephalographs Features and Cerebral Blood Flow

ABSTRACT. Two cases of happy puppet or Angelman syndrome are presented. They have the typical clinical features and represent the first Swedish cases. One of the patients is a man of 75 years of age, which shows that this form of severe mental retardation is well compatible with long life. Extended EEG monitoring may identify the typical EEG abnormality when this is difficult to demonstrate in routine EEG records. The typical laughter has no specific correlate in the EEG and thus is probably not an epileptic manifestation. Regional cerebral blood flow studies were normal in the young patient (11 years of age) but in the older patient showed a reduced cerebral circulation, compatible with organic dementia

Hip Joint Instability in Breech Pregnancy

ABSTRACT. 222 consecutive fetuses found by ultrasound to be in breech presentation in the 33rd gestational week were followed with repeated examinations in weeks 35 and 38. Ninety‐one of these fetuses persisted in breech presentation until delivery, while cephalic version occurred in 131. The frequency of hip joint instability was 21% in the breech delivered group and 1.5% in the vertex delivered group. The position of the fetal legs was established at each ultrasound examination. The intrauterine fetal attitude was classified as extended when the fetuses had extended knees and maximally flexed hips at all ultrasound examinations. This occurred in 30 breech delivered fetuses, 47% of which developed hip joint instability. Only 8% of the breech born infants with flexed legs in utero developed hip joint instability. It is concluded that instability of the hip joint is a consequence of the intrauterine attitude, rather than of the breech delivery per se.

NEUROLOGICAL INVESTIGATION OF 5‐YEAR‐OLD CHILDREN WITH LOW BIRTHWEIGHT

ABSTRACT: Bjerre, I. (Department of Paediatrics, Malmo General Hospital, Malmo, Sweden). Neurological investigation of 5‐year‐old children with low birthweight. Acta Paediatr Scand, 64: 859, 1975.–139 children with a low birthweight (LBW), i.e. not more than 2500 g, were examined at 5 years of age in respect of their neurological status, with special reference to motor coordination according to Touwen & Prechtl. 5 (3.6%) children had cerebral palsy; 13 (9.4%), minimal brain dysfunction; 38 (27.3%), delayed motor maturation; and 83 (59.7%), normal motor development and normal neurological status. Impairment of hearing and of vision, epilepsy and mental retardation were more common in children with cerebral palsy and MBD, Children with MBD and delayed motor maturation had a lower IQ, as judged from the draw‐a‐mantest according to Goodenough than children with normal neurological status. Cerebral palsy was found in children with a very low birthweight and short gestational age. Other findings were equally distributed among groups classified by weight and duration of gestation.