[Effectiveness of complex screening procedure in the diagnostics of cerebral palsy in preterm infants with suspected hypoxic-ischaemic brain injury].
OBJECTIVE
To evaluate the effectiveness of a complex neurological screening (cns clinical examination, magnetic resonance imaging of the head, serial cranial ultrasound record) -- in the diagnosis of cerebral palsy in infants born preterm, with symptoms of perinatal hypoxia.


METHODS
Prospective study in 23 preterm infants born between 27 and 36 weeks of pregnancy with features of intrauterine and postnatal hypoxia. In the study infants underwent a complete neurological examination: MRI and cranial ultrasound were carried out approximately from the term of birth and then follow-up with repeated neurological examination and cranial ultrasound at 3rd, 6th and after the 12th month of corrected age.


RESULTS
Significant statistical relationship has been found between cerebral palsy and the following changes: hypoxic-ischaemic changes diagnosed by MRI, hypoxic-ischaemic changes diagnosed by ultrasound conducted about term of birth as well as cerebral atrophy observed in ultrasound scans within the first six months of adjusted age and incorrect primitive reflexes within the first six months of adjusted age. Combination of the MRI findings at term of birth with the evaluation of primitive reflexes within the first six months of corrected age showed 100% sensitivity and 100% specificity. No statistically significant relationship has been found between the neurological conditions after the 12th month and at 40 weeks after conception and with psychomotor development within the first six months of corrected age.


CONCLUSIONS
Magnetic resonance imaging at term of birth combined with repeated complete neurological examination within the first six months of corrected age is an effective method ensuring early diagnosis of cerebral palsy in preterm infants. The assessment of psychomotor development in preterm infants within the first six months of corrected age without a full neurological examination is insufficient for an early diagnosis of cerebral palsy.
Klinika Neonatologii, Pomorska Akademia Medyczna, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland. mkkimejl@op.pl
Grazyna
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Hnatyszyn
D002547:Cerebral Palsy / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications* / Q000000981:diagnostic imaging; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D010808:Physical Examination; D011044:Poland; D014463:Ultrasonography