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"Child`s Health" 8 (51) 2013

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Predicting the Outcomes of Perinatal Nervous System Damage in Preterm Infants

Authors: Alifanova S.V. - State Institution «Dnipropetrovsk Medical Academy of Ministry of Public Health of Ukraine», Dnipropetrovsk, Ukraine

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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Premature infants with very low birth weight (VLBW) and extremely low birth weight (ELBW) at birth are at risk for developing long-term neurological impairment and disability, which is a serious medical and social problem. To evaluate the neurological function in children and early diagnosis of disorders in clinical practice, it is important to have a reliable and simple to use non-invasive screening methods. The standardized scale INFANIB (Infant Neurological International Battery, 1995) may be used in premature babies for this purpose.

Objective: clinical evaluation of the parameters of mental development in the first year of life in preterm born infants with VLBW and ELBW using a scale INFANIB, aimed to predict neurological disorders.

Materials and methods. We observed 56 children who were born in gestational age from 26 to 34 weeks. The children were divided into two groups. I group were 21 children born at gestation term of 26–30 weeks with ELBW 870–1000 g, the II group included 35 children born at term of gestation of 31–34 weeks with VLBW 1000–1500 g. Follow-up included a complete clinical and instrumental examination with the assessment of the physical and psychomotor development, somatic status, and evaluation using a standardized scale INFANIB (1995) at the adjusted age (AA) of 1, 3, 6, 9 and 12 months. According to INFANIB scale score children were classified as: normal, transient or abnormal.

Results and discussion. Analysis of ante- and perinatal periods of life in children revealed a complicated course in 90.5 % of the mothers in I group and in 88.6 % of the mothers in group II. In the structure of morbidity in the early neonatal period no significant differences between groups were found. All children were diagnosed with perinatal injury of the central nervous system, mostly of hypoxic-ischemic origin. Analysis of CNS trauma revealed that intraventricular hemorrhage of degree II and higher reported in 28.6 % of children in group I and in 22.9 % of children in Group II, cystic periventricular leukomalacia of II and higher degree was diagnosed in 19 % of children in group I and 17.1 % of the children in Group II. Apnea syndrome was observed in 42.9 % of children in group I and 40 % in group II, necrotizing enterocolitis in 28.6 % and 25.7 % of the children in both groups, intrauterine infection — in 19 % and 17.2 % of children in both groups respectively, sepsis — in 4.8 % and 5.7 % of children in both groups, respectively. On evaluation of the psychomotor development using INFANIB scale in AA of 1 month the children of both groups revealed comparable results. In children with ELBW average birth rate was 46.38 ± 5.72 points, in children with VLBW — 48.74 ± 6.16 points. There were no children with normal score, abnormal was diagnosed in 52.4 % of children in group I and 45.7 % of children in Group II, the range of transient respectively had 47.6 % and 54.3 % of children. In assessing with the INFANIB scale at the AA of 3 months there was a statistically no significant increase in the average score in children in both groups, the range of normal received 42.9 % of children in group I and 45.7 % of children in Group II, the range transient — respectively, 33.3 % and 31.4 % of the children, range abnormal had 23.8 % and 22.9 % of patients in both groups. Statistically significant differences in frequency of ranges in groups at the AA of 3 months also were absent. When checked at the AA of 6 months there was determined that muscle and postural tone significantly increased in children of group II (p < 0.05), and the children in group I did not differ significantly from the overall assessment at the AA of 3 months. In the future, the pace of development in the children of I and II groups had some differences and irregular course with periods of lack of significant positive dynamics in children in group I at the age of 3–6 months, and in children of group II at the age of 6–9 months it was due to motor disorders, delayed reduction of tonic reflexes and spinal automatism. The rate of normalization of muscle tone, posture and motor function, evaluated on a scale INFANIB, were generally higher in children of group II, but children of both groups had formed a subgroup corresponding to the range of abnormal by the AA of 9–12 months. Such children were at risk of development of severe neurological disorders, especially cerebral palsy.

Conclusions. 1. Described features in the course of neurological disorders corresponded to severity of the ante-, intra-, and neonatal cerebral damage and to the degree of gestational maturity of the children.

2. Diagnosing of the severity of neurological disorders in children born prematurely with VLBW and ELBW, using a standardized INFANIB scale allows to suspect the formation of cerebral palsy in children with score corresponding to ranges of transient and abnormal.

3. Particular attention should be paid to children with score corresponding to the range of transient because in the future, any outcome is possible — normal development of the child, the development of minor neurogenic dysfunction or severe neurological disorders, up to the formation of cerebral palsy.

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