title: Slow pupillary light responses in infants at high risk of cerebral palsy were associated with periventricular leukomalacia and neurological outcome.
abstract: OBJECTIVE
  Having observed slow pupillary light responses (PLRs) in infants at high risk of cerebral palsy, we retrospectively evaluated whether these were associated with specific brain lesions or unfavourable outcomes.
  
  
  METHODS
  We carried out neurological examinations on 30 infants at very high risk of cerebral palsy five times until the corrected age of 21 months, classifying each PLR assessment as normal or slow. The predominant reaction during development was determined for each infant. Neonatal brain scans were classified based on the type of brain lesion. Developmental outcome was evaluated at 21 months of corrected age with a neurological examination, the Bayley Scales of Infant Development Second Edition and the Infant Motor Profile.
  
  
  RESULTS
  Of the 30 infants, 16 developed cerebral palsy. Predominantly slow PLRs were observed in eight infants and were associated with periventricular leukomalacia (p = 0.007), cerebral palsy (p = 0.039), bilateral cerebral palsy (p = 0.001), poorer quality of motor behaviour (p < 0.0005) and poorer cognitive outcome (p = 0.045).
  
  
  CONCLUSIONS
  This explorative study suggested that predominantly slow PLR in infants at high risk of cerebral palsy were associated with periventricular leukomalacia and poorer developmental outcome. Slow PLR might be an expression of white matter damage, resulting in dysfunction of the complex cortico-subcortical circuitries.
authors.affiliation: University of Groningen, University Medical Center, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands.
authors.forename: Elisa G
authors.initials: EG
authors.lastname: Hamer
authors.affiliation: VU University Medical Center, Department of Child Neurology, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors.forename: R Jeroen
authors.initials: RJ
authors.lastname: Vermeulen
authors.affiliation: University of Groningen, University Medical Center, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands.
authors.forename: Linze J
authors.initials: LJ
authors.lastname: Dijkstra
authors.affiliation: University of Groningen, University Medical Center, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands.|University of Groningen, University Medical Center, Department of Rehabiltation, Groningen, The Netherlands.
authors.forename: Tjitske
authors.initials: T
authors.lastname: Hielkema
authors.affiliation: University of Groningen, University Medical Center, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands.
authors.forename: Claire
authors.initials: C
authors.lastname: Kos
authors.affiliation: University of Groningen, University Medical Center, Department of Paediatrics, Division of Neonatology, Groningen, The Netherlands.
authors.forename: Arend F
authors.initials: AF
authors.lastname: Bos
authors.affiliation: University of Groningen, University Medical Center, Department of Paediatrics, Division of Developmental Neurology, Groningen, The Netherlands.
authors.forename: Mijna
authors.initials: M
authors.lastname: Hadders-Algra
mesh_terms: D002547:Cerebral Palsy / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D007969:Leukomalacia, Periventricular / Q000175:diagnosis* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D009460:Neurologic Examination; D012025:Reflex, Pupillary; D012189:Retrospective Studies
keywords: Cerebral palsy; Infants; Neuroimaging; Periventricular leukomalacia; Pupillary light response