Neurologic status and intracranial hemorrhage in very-low-birth-weight preterm infants. Outcome at 1 year and 5 years
L. M. Ford, J. Steichen, P. A. Steichen Asch, D. Babcock and M. H. Fogelson
Department of Pediatric Neurology, Children's Hospital Medical Center, Cincinnati, OH 45229.
Twenty-six very-low-birth-weight preterm infants with and without
intracranial hemorrhage (ICH) were followed up prospectively from birth to
school age to determine the relationship between ICH and subsequent
neurologic and cognitive outcomes. All children had sequential cranial
ultrasound examinations at birth and neurologic assessments at 3-month
intervals during the first year, at 1 year of age, and at 5 to 6 years;
psychometric assessments were done at 5 to 6 years. Seventeen children had
no ICH, 3 had grade 1 ICH, 1 had grade 3 ICH, and 5 had grade 4 ICH. The
1-year Amiel-Tison neurologic assessment in 25 infants demonstrated that 14
were normal, 3 were suspect, and 8 were abnormal. By 5 to 6 years of age, 5
of 8 children neurologically abnormal at 1 year remained abnormal, 2 of 3
children neurologically suspect at 1 year remained suspect; while 9 of 15
children neurologically normal at 1 year remained normal, the remaining 6
had become suspect. The predominant neurologic abnormality at 5 to 6 years
was subtle neurologic dysfunctioning. The Wechsler Preschool and Primary
Scale of Intelligence at 5 to 6 years revealed a mean group IQ score of
92.1. The Beery Visual Motor Integration Test results demonstrated that 18
of 26 children had mild to severe visual motor perceptual difficulties.
Severe ICH (grades 3 and 4) correlated with abnormal neurologic
performances at 1 and 5 to 6 years. Mild ICH (grade 1) and no ICH did not
correlate with any one of the 1-year neurologic classifications. The 1-year
status correlated with the 5- to 6-year neurologic outcome best for
children who were either neurologically suspect or abnormal at age 1 year.
The 1-year neurologic score did not correlate with 5- to 6-year IQ and
Beery Visual Motor Integration Test scores.
