Mary Ellen A. Bozynski

Cognitive performance at school age of very low birth weight infants with bronchopulmonary dysplasia.

The hypothesis was that bronchopulmonary dysplasia (BPD) adversely affects cognitive performance at school age. This prospective cohort study examined three groups of children at 8 to 10 years of age. Group 1 (n = 311) consisted of very low birth weight (VLBW) infants without BPD and Group 2 (n = 95) consisted of VLBW infants with BPD. Group 3 (n = 188) consisted of term infants without BPD. Regression analysis determined the effect of BPD on eight performance measures while controlling for possible confounding variables. Children in Group 3 had the best performance and children in Group 2 had the poorest performance on all measures. These differences were significant (p = .0001) for the Full Scale IQ, Performance IQ, and reading and math grades and ages. Children in Groups 3 and 1 performed better than children in Group 2 for the Verbal IQ (p = .0001) and the Developmental Test of Visual-Motor Integration (p = .0012), but for these two measures there was no significant difference between children in Groups 3 and 1. Thus, poorer performance was found in VLBW infants with a history of BPD.

Neonatal purpura fulminans in association with factor V R506Q mutation

We report a case of neonatal purpura fulminans associated with activated protein C resistance. Analysis of DNA demonstrated heterozygosity for the factor V R506Q mutation. The neonate, at 8 hours of age, had progressive purpuric skin lesions and later had evidence of microvascular, hemorrhagic thrombosis in the brain. The baby was treated with fresh frozen plasma infusions and had complete resolution of the skin lesions and no apparent long-term complications. We suggest that activated protein C resistance testing be included in the initial evaluation of neonatal purpura fulminans.

CRANIAL UL‐RASONOGRAPHY AND THE PREDICTION OF CEREBRAL PALSY IN INFANTS WEGHING ≤ 1200 GRAMS AT BIRTH

The rôle of serial cranial ultrasonography in the prediction of cerebral palsy was examined in 116 surviving infants with birthweights ≤ 1200g. All underwent serial real‐time sonographic examinations of the brain on days one, five and 21, then monthly, until term corrected age. Intraventricular hemorrhage (IVH) was diagnosed in 48 infants, and three had periventricular leukomalacia. Of the 116 infants, 31 had ultrasound abnormalities at term. At 12 to 18 months corrected age 12 infants had cerebral palsy and 38 were classified as suspect; the other 66 were normal. There was a clear association between risk group, based on sonographic findings at term, and outcome. Infants with IVH whose cranial ultrasounds failed to become normal by term corrected age were at higher risk for cerebral palsy than those with normal examinations at term, regardless of the severity of IVH. Thus an abnormal ultrasound at term corrected age was highly predictive of cerebral palsy, especially among survivors of IVH. It remained the best predictor of cerebral palsy, even when other perinatal and neonatal variables were considered. In contrast, duration of mechanical ventilation, rather than sonographic findings, was the best predictor of suspect neuromotor status.

Use of high-frequency jet ventilation in the management of congenital tracheoesophageal fistula associated with respiratory distress syndrome

Two preterm infants (28 weeks, 960 g; 32 weeks, 1,870 g) with very large tracheoesophageal fistulas suffered from respiratory distress syndrome and failed to respond to conventional mechanical ventilation despite placement of a decompressive gastrostomy. Pulmonary air leaks developed in both, resulting in transdiaphragmatic pneumoperitoneum, and significant gas flow occurred through the gastrostomy tube despite placement under water-seal. High-frequency jet ventilation was instituted in each case and resulted in improved pulmonary gas exchange at lower mean airway pressure (12.0 to 6.7 cm H2O; 11.0 to 8.0 cm H2O) and in prompt resolution of air leaks. Both patients remained refractory to reinstitution of conventional ventilation until division of the fistula in the first patient and complete resolution of the respiratory distress syndrome in the second.

Cranial sonography and neurological examination at term and motor performance through 19 months of age

This study examined the role of cranial sonography and neurological examination in the prediction of developmental progress during the first 19 months of life in extremely preterm infants. Forty-seven infants with mean birth weight 993 ± 197 g and gestational age 27.9 ± 1.9 weeks were studied. Each infant was classified as normal, suspect, or abnormal using cranial sonography and a structured neurological examination. Developmental outcome was assessed using the Infant Neurological International Battery (INFANIB) at 4, 8, and 14 months and the Rockford Infant Developmental Evaluation Skills (RIDES) at 19 months. Sonographic classification was the best predictor of outcome through 14 months, F(2.72) = 12.4, p < .001. The neurological examination predicted performance only at 4 months. No infant classified as normal on both examinations was abnormal on follow-up. Infants with suspect or abnormal neurological examinations had normal outcomes if their sonographic findings were normal.

Cranial sonography and neurological examination of extremely preterm infants.

Fifty‐one extremely preterm infants were studied to ascertain whether there is an association between sonographic abnormalities and neurological examination at term, controlling for factors such as low birthweight and chronic lung‐disease. Their mean birthweight was 956g and mean gestational age was 27·9 weeks. Sonography was performed at least once during the first week, twice within the first month, and once within a month of term‐corrected age. Neurological assessment was used to classify the infants as normal, suspect or abnormal at term. Infants were divided into three groups, based on sonographic findings: group 1 (no hemorrhage), group 2 (grade 1 to 3 hemorrhage but normal sonogram or unilateral ventriculomegaly at term) and group 3 (periventricular leukomalacia, grade 4 hemorrhage or ventriculomegaly at term). On neurological examination, 23 infants were found to be normal, 15 suspect and 13 abnormal. On sonography, 27 infants were placed in group 1, 12 in group 2 and 12 in group 3. Sonographic findings and birthweight were the best predictors of the infants performance on the neurological examination at term.

Effects of experience and case difficulty on the interpretation of pediatric radiographs

No abstract available.

Cognitive performance at school age of infants with bronchopulmonary dysplasia. |[bull]| 1179

The study hypothesis was that bronchopulmonary dysplasia (BPD) adversely affects cognitive performance at school age. This prospective cohort study examined three groups of children. Two groups were selected from a reconstructed cohort of very low birth weight (VLBW) infants previously enrolled in a multi-site, randomized, controlled, clinical trial. Group 1(n=311) included infants without BPD and group 2 (n=95) included infants with BPD. A control group of full term infants without BPD (group 3, n=188) was selected from a cohort assembled for a previous program supported by the Robert Wood Johnson Foundation. All of the children were assessed at 8-10 years of age in the following areas: full, verbal, and performance intelligence quotients (IQs), reading grade and age, math grade and age, and the Developmental Test of Visual-Motor Integration (VMI). Possible confounding variables were also recorded. Linear regression models were designed to determine the effect of BPD on the performance measures while controlling for confounding variables. Children in group 3 had the best performance and children in group 2 had the poorest performance on all eight cognitive measures. These differences were significant (p=0.0001) for the full IQ, performance IQ, reading grade and age, and math grade and age. Children in groups 3 and 1 performed better than children in group 2 for the verbal IQ(p=0.0001) and the VMI (p=0.0012), but for these two measures there was no significant difference in performance between children in groups 3 and 1. The 15 confounding variables affected scoring on each of the performance measures to varying degrees. Controlling for the confounding variables showed that levels of maternal education and history of cerebral palsy or hydrocephalus partially explained certain differences in performance between the three groups. In conclusion, the cognitive performance at school age of infants with a history of BPD was generally poorer than the performance of VLBW and full term children without a history of BPD.

1467 CHARACTERISTICS OF LBW INFANTS DISCHARGED ON MONITORS/THEOPHYLLINE

The number of NICU infants discharged on Theo and/or monitors has been increasing. Of 68 graduates in 1983-1984 with BW ≤1200 gm, 23 were discharged on therapy. We have compared the population discharged on monitors/Theo (treated) with the remaining ≤1200 gm graduates (untreated). Both groups had similar PCA at birth (treated 28.6 wks vs untreated 29.1 wks, N.S.) and at discharge (treated 41.7 wks vs untreated 40.1 wks, N.S.). Treated infants were more often male (70% vs 40%) and not Black (52% vs 31%). IVH did not differentiate treated (8/23) vs untreated (19/42), nor did chronic lung disease (13/23 treated vs 17/42 untreated). For the 23 treated patients, 19 discharge pneumograms (PCG) were evaluated, 7 while on Theo. Five were normal/borderline; 14 were abnormal. For untreated patients, 24 PCGs were available, all normal/borderline off Theo. Of treated infants PCGs, 13/19 had A6D≥0.5%, 9/19 had bradycardia, 5/19 had PB>3.5% and 4/19 had apnea ≥15 seconds. Five studies had 1 abnormality, 7 had 2, and 4 had 3. With the increasing use of PCGs, more infants born in 1984 were treated when compared to 1983 (11/45 in 1983 vs 12/20 in 1984, p<0.05). One death occurred in an untreated black female with a normal PCG prior to discharge. We conclude for LBW infants: 1) the demographically at-risk population for apnea/bradycardia at term is the white male; 2) neither chronic lung disease nor IVH necessarily lead to abnormal term PCGs and 3) the use of the PCG at discharge leads to an increase in monitoring and/or Theo treatment.

1348 CAVITARY PERIVENTRICULAR LEUKOMALACIA (PVL): INCIDENCE AND SEQUELAE

Recent real-time ultrasonographic studies have shown that the diagnosis of cavitary PVL can be made in vivo. From 1-31-82 to 6-30-84 all infants weighing ≤ 1200 g were screened for intracranial hemorrhage (ICH) using real-time ultrasonography at 1, 2, and 4 weeks postnatal age and at least monthly through term corrected age. PVL was diagnosed in 6/119 survivors. ICH was seen in 45/119 including 4 of 6 infants with PVL. Cavitary lesions of PVL were first diagnosed at 4-6 weeks postnatal age in all. Some lesions were undetectable by 10-12 weeks. Follow-up data is presented below.Poor visual attention at term was noted on the Brazelton Neonatal Assessment Scale in all patients.*Age corrected for prematurity in months.Conclusion: PVL is a marker for cerebral palsy and may occur in the absence of ICH. Careful longitudinal scanning, past the usual time of ICH is mandatory for diagnosis.