Luca Ori

Preterm birth and developmental problems in the preschool age. Part I: minor motor problems

Nearly half of very preterm (VP) and extremely preterm (EP) infants suffers from minor disabilities. The paper overviews the literature dealing with motor problems other than cerebral palsy (CP) during infancy and preschool age. The term “minor motor problems” indicates a wide spectrum of motor disorders other than CP; “minor” does not mean “minimal”, as a relevant proportion of the preterm infants will develop academic and behavioural problems at school age. Early onset disorders consist of abnormal general movements (GMs), transient dystonia and postural instability; these conditions usually fade during the first months. They were underestimated in the past; recently, qualitative assessment of GMs using Prechtl’s method has become a major item of the neurological examination. Late onset disorders include developmental coordination disorder (DCD) and/or minor neurological dysfunction (MND): both terms cover partly overlapping problems. Simple MND (MND-1) and complex MND (MND-2) can be identified and MND-2 gives a higher risk for learning and behavioural disorders. A relationship between the quality of GMs and MND in childhood has been recently described. The Touwen infant neurological examination (TINE) can reliably detect neurological signs of MND even in infancy. However, the prognostic value of these disorders requires further investigations.

The ontogeny of fidgety movements from 4 to 20 weeks post-term age in healthy full-term infants

BACKGROUND Fidgety movements (FMs) are an early accurate marker for normal development. AIM The study assessed the ontogeny of normal FMs from 4 to 20weeks post-term age (PTA). STUDY DESIGN Longitudinal prospective study of healthy full-term infants video recorded every second week from birth to 20weeks PTA. SUBJECTS 21 full-term newborns were enrolled. OUTCOME MEASURES Temporal organization, amplitude, character, predominance in proximal and/or distal parts of the body and the presence of FMs in fingers and wrists were independently scored by three observers. RESULTS From 4 to 10weeks PTA, FMs were sporadic, becoming intermittent in 1-2weeks; they occurred in the proximal parts, with larger and jerkier movements in the following period. From 11 to 16weeks PTA FMs became smaller in amplitude and slower in speed, they were present in all body parts and were more continual than before. Rotational movements in wrists and ankles and finger movements with open hands appeared. From 17 to 20weeks PTA, FMs became more discontinuous and disappeared at 18-20weeks PTA. CONCLUSIONS Developmental course of FMs was seen between 4 and 20weeks PTA with changes in temporal organization, amplitude, speed and body parts involved. The best time for scoring FMs is between 12 and 16weeks PTA.

Hypothermia reduces seizure burden and improves neurological outcome in severe hypoxic-ischemic encephalopathy: an observational study.

To evaluate the antiepileptic effect of hypothermia and its association with neurological outcome in infants with moderate and severe hypoxic–ischemic encephalopathy (HIE).

Neurological Examination of the Newborn Infant

A simple neurological screening examination should be performed on all newborn infants as part of the general medical examination. It should consist of an assessment of state of consciousness-reactivity, spontaneous motor activity, neck, trunk and limb muscle tone and some primitive reflexes (e.g. suck and grasp. Not all experts include the Moro reflex in the general examination on the basis that it is cruel to startle a person) [1].

Maternal Voice and Its Influence on Stress and Sleep

Introduction: Several developmental care programmes in NICU have been created to minimize the consequences of prematurity and to promote preterm infant’s neurobehavioral and brain development. The foetus in the womb relies on the organic structure of the rhythms of mother’s heart, her breath patterns and overtone vibrations of her “voice-supported” organizational development. Preterm birth interrupts the dialog between mother and foetus: changes of the sensory inputs and mother-driven environmental enrichment at this stage deeply affect the brain development and the stress regulation.