Patricia Naughton

CAVITARY PERIVENTRICULAR LEUKOMALACIA: INCIDENCE AND SHORT-TERM OUTCOME IN INFANTS WEIGHING ≥1200 GRAMS AT BIRTH

One hundred surviving infants with birthweights ≥1200g were examined longitudinally, using real‐time ultrasonography of the brain. Five infants were diagnosed as having cavitary periventricular leukomalacia (PVL). One infant expired within a month following discharge; the remaining four entered a follow‐up program and received developmental assessments. Three infants had moderate‐severe spastic diplegia and the fourth had spastic quadriplegia. Cavitary PVL can be diagnosed in vivo and predicts future motor delay or cerebral palsy. Since the typical site of PVL involves the optic radiations, and the incidence of visual‐perceptual disturbances is high in premature infants, fürther research is needed to explore the possible relationship between these two abnormalities.

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.

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.

FAMILY VARIABLES IN THE FOLLOW-UP OF PREMATURE INFANTS

The importance of family variables for the development of the premature newborn and the provision of adequate follow-up care was examined. Data were collected on infant medical status, characteristics of the primary caregiver, and variables in the broader family context thought to interact dynamically to affect the developing infant and family. 23 high risk infants (25-32 weeks gestation) and their mothers were assessed three times during the early postpartum months, and compared with 23 low risk infants and their mothers given parallel evaluations. The low risk infants were matched on race, sex, education of the mother, and marital status of the mother. Persistent differences were found between the high and low risk infants through four months of age on both behavioral and developmental exams. The two groups of mothers also differed significantly on measures of anxiety and psychological discomfort. Variability in maternal distress for the mothers of high risk infants was not associated with the infants biomedical problems in the perinatal period or with the results of behavioral or developmental assessments of the infant. Instead, maternal distress reflected the level of social supports available in the broader family context, with low social supports related to increased distress. The findings indicated that having a baby prematurely is a very powerful perturbation for the mother, and that family and community support may be able to buffer her distress.