Cerebral handicap in full-term newborns related to late pregnancy and/or labor.
The improving results of modern obstetrics, anesthesiology and immediate pediatric care have to be assessed. Clinical methods are available, providing guidelines for a simple neuro-sensorial assessment of the full-term newborn. When abnormalities are detected at the first assessment, the newborn will be assessed daily or every other day, as the symptomatology often rapidly changes. Based on these repeated evaluations, a gradation of 3 levels of severity is established, by the end of the first week: mild (1) includes tone abnormalities and hyperexcitability but no seizures and no CNS depression; moderate (2) includes CNS depression +/- isolated seizures; severe (3) includes coma and repeated seizures. Though this gradation represents an empirical cut-off in a continuum of signs and symptoms indicating brain dysfunction at birth, correlations with late outcome are reasonably good. Individual prognosis is out of our reach, specially in grade 2 infants. However, as a group estimation of late outcome, this gradation is satisfactory. Neurobehavioral competence in the full-term newborn is such that one assessment performed within normal limits in the first 3 days allows a reasonable prediction of a normal outcome, no matter how dreadful the pregnancy and/or delivery has been. Therefore neurological assessment of the full-term newborn in the first week of life can be considered as a good marker for the quality of perinatal care, and good feed-back information for the obstetrical staff.(ABSTRACT TRUNCATED AT 250 WORDS)
Amiel-Tison
C
C
Baudelocque Maternity Hospital, Paris, France.
D001720:Birth Injuries / Q000175:diagnosis* / Q000453:epidemiology; D001925:Brain Damage, Chronic / Q000175:diagnosis; D001927:Brain Diseases / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008430:Maternal-Child Health Centers; D009460:Neurologic Examination / Q000379:methods; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011273:Pregnancy, Prolonged; D012189:Retrospective Studies