Neurological examination of preterm infants at term equivalent age.
BACKGROUND
We previously reported the neurological findings of the Dubowitz neonatal examination in a cohort of 157 low-risk preterms born between 25 and 33 weeks gestational age (GA) and examined at term equivalent age (TEA). Median and range of scores were wider than those found in term-born infants and preterms showed a different neurological behaviour in specific items. However, the cohort number was too small to draw any definitive conclusion about the distribution of findings.


OBJECTIVE
We provide normative data from a low-risk cohort of 380 preterm infants; we also assess the findings and their relationship to motor outcome in preterms with major cranial ultrasound (US) abnormality.


METHODS
We assessed, at TEA, 380 low-risk preterms born <35 weeks gestation (range 25-34.9, median 29) with normal 2 year motor outcome and 85 preterm infants with major US abnormality.


RESULTS
At TEA low-risk preterms had less flexor limb tone, poorer head control but better visual following than term-born infants. For 28/34 of the neurological items the range and median scores were similar across gestational ages. In infants with major US lesions the range and median scores differed from low-risk preterms in 20/34 items; 40% of infants developing a diplegia and 80% developing a tetraplegia had >7 items outside the 90th centile; all infants with >12 items outside the 90th centile developed a tetraplegia.


CONCLUSIONS
We provide reference values for the neurological examination of low-risk preterms at TEA. In infants with major US abnormality the number of items outside the 90th centile was an indicator of outcome severity.
Ricci
Daniela
D
Department of Paediatrics and Imaging Sciences, Hammersmith Campus, Imperial College, London, UK. daniricciola@libero.it
Romeo
Domenico M M
DM
Haataja
Leena
L
van Haastert
Ingrid C
IC
Cesarini
Laura
L
Maunu
Jonna
J
Pane
Marika
M
Gallini
Francesca
F
Luciano
Rita
R
Romagnoli
Costantino
C
de Vries
Linda S
LS
Cowan
Frances M
FM
Mercuri
Eugenio
E
D015331:Cohort Studies; D005865:Gestational Age; D006801:Humans; D018730:Infant Behavior / Q000502:physiology*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D009129:Muscle Tonus / Q000502:physiology; D009460:Neurologic Examination / Q000379:methods*; D011187:Posture / Q000502:physiology; D011446:Prospective Studies