Samuel A. Saxon

Developmental sequelae in infants having suffered severe perinatal asphyxia

Abstract Fifteen of 20 infants surviving perinatal asphyxia (Apgar ≤ 3) necessitating resuscitation with positive-pressure oxygen and intravenous buffer were compared with 14 healthy mature nonasphyxiated infants 15 to 40 months after birth. Ten asphyxiated and 11 nonasphyxiated infants had normal neurologic examinations while two asphyxiated and three nonasphyxiated babies had borderline results. The three intrauterine growth-retarded babies in the asphyxia group all had neurologic deficits. Excluding these three badly damaged growth-retarded babies (mean I.Q. = 31), mean I.Q. scores of asphyxiated and nonasphyxiated groups were identical (96, asphyxiated; 96, nonasphyxiated). These preliminary data suggest a good prognosis for acutely asphyxiated infants managed with current techniques of resuscitation.

Effects of early neurological problems following head trauma on subsequent neuropsychological performance.

Early neurological indicants based on information from the hospital admission clinical examination were studied in a group of patients who had sustained accident‐incurred traumatic head injuries. Patients who had been hospitalized during the 3‐year period just preceding the study were recalled and a battery of neuropsychological tests was administered. Early neurological problems were found to have a detrimental effect on subsequent test performance. The results supported the use of these early indicants to make prognostic decisions.

Long‐term neuropsychological deficits after traumatic head injury with comatosis

Studied neuropsychological deficits in a population who had sustained traumatic head injuries of the concussive type. Experimental Ss were 48 adults who had been comatose and hospitalized during the 3-year period that preceded the study. Control Ss (N = 16) had been hospitalized due to other types of injuries and had not been comatose. Ss were recalled and administered the Halstead-Reitan Battery, Trail Making Test, WAIS, and various questionnaires. Significant differences between experimental and control Ss were found that indicated persistence of neuropsychological dysfunctions. Groups of Ss who had sustained long comas performed more poorly than those who had short comas, which indicated that duration of coma was an important factor.

Construct validity of three rating scales for hyperactivity

Abstract The construct validity of three previously published rating scales used to screen for hyperactivity was assessed. Fifty children ranging in age from 3.4 to 8.3 years were rated by their parents. Three objective measures of activity were also obtained on the children. Results suggest that the rating scale scores of the children did not predict their activity level and no support for the scales having construct validity was found.

Activity level patterns in the hyperactive ritalin responder and non‐responder∗

Abstract The activity level of ten hyperactive children (five who were Ritalin responders and five who were non‐responders) and five controls was measured on two occasions for four consecutive 5‐minute periods. Although overall activity levels did not vary significantly among the groups, there was a significant interaction effect. The Ritalin responders (on no medicine at the time of the study) became less and less active in the confines of the small, bare playroom. The hyperactive children who were Ritalin non‐responders became more and more active in the same situation. The control subjects did not vary significantly. Implication for the behavioral assessment of hyperactives are made.

Correlation between Halstead Impairment Index and Average Impairment Rating

The Halstead-Reitan Battery is frequently used to assess brain damage. Russell, Neuringer, and Goldstein (1970) developed the Average Impairment Rating to be used in place of the Halstead Impairment Index. Borh measures are derived from a similar group of subtest scores. The literature abounds with data on the Impairment Index, but little is known about how comparable the two measures are, and data were collected to show the relationship. Subjects were 48 young adults who had received head injuries resulting in comatosis (median period 48 hr.) and hospitalized for a mean period of six weeks. A group of 16 subjects who were involved in accidents but did not have head injuries served as controls. A mean period of 18 mo, had elapsed since injury. Subjects were randomly selected from the hospitalized population and were recalled and administered the Halstead-Reitan Battery. Mean Impairment Index and Average Impairment Rating scores were .72 and 2.06, respectively, for head injured subjects, .37 and 1.18 for controls, and .63 and 1.84 for all 64 subjects. The measures were significantly correlated ( p < ,001) with Pearson coefficients of .82 for subjects with head injuries, .87 for controls, and .88 for all subjects. Subjects were grouped according to Overgaards (1973) criteria and analyses of variance were done comparing severe (Overgaards Class A and B) and mild (Class C) neurological problems and controls. Mean Impairment Index and Average Impairment Rating scores were .81 and 2.45, respectively, for severe injuries, .69 and 1.95 for mild injuries, and .37 and 1.18 for controls. When analyses using one raring were significant, analyses using the other were also significant. When comparisons were, made between groups with mild versus severe neurological problems, the Impairment Index was significant ( p < .05) as was the Average Impairment Rating ( p < ,005). These data indicate that the two indexes are highly correlated and the Average Impairment Rating is at least as sensitive as the Impairment Index. More research is needed to determine any real differences.

64 INTERDISCIPLINARY ASSESSMENT OF MORBIDITY OF INFANTS WITH BIRTHWEIGHTS ≤ 950 GRAMS

26/31(84%) surviving NICU infants with birthweights ≤950 g.born 4/74-1/77 were evaluated by an interdisciplinary team including pediatricians(2), psychologist, audiologist, optometrist, developmentalist, social worker, nutritionist and R.N. The study began in 1/76 with evaluations performed at ages 6, 12, 18, 24 and 36 mos. Mean age at last evaluation was 18 mos.(range 6-38 mos.). Population characteristics included mean birth weight 889 g.(range 650-940 g.); mean gestational age 28.4 wks.(range 24-33 wks., 7/26 small for gestational age); male:female 10:16; inborn:outborn 5:21; and Black:White:Other 13:12:1. Results were corrected for gestational age.Significant major morbidity was found in 9/26(34.6%)including stage V retrolental fibroplasia (RLF)(1); developmental delay (7 with DQ≥70); cerebral palsy(6); acquired hydrocephalus(2); extreme failure to thrive (FTT)(3). 6/9(67%) affected infants had multiple major handicaps. 11/17 infants without major handicaps had one or more minor disabilities including stage II RLF(1); recurrent lower respiratory disease(4); serous otitis media(11); mild conductive hearing loss(8); mild FTT(2); visual disorders(4) arrested hydrocephalus(3) and scoliosis(1). Although longitudinal followup may alter some of the results reported, it appears that survival without major morbidity is occurring in 65% of surviving infants with birthweights ≥950 g.