[Prognostic predictive value of neonatal ultrasonic studies of the CNS and of EEG monitoring for the psychomotor development at 1 year of age]. / Der prognostische Aussagewert der neonatalen Ultraschall-Untersuchung des ZNS und des EEG-Monitorings für die statomotorische Entwicklung im Alter von 1 Jahr.

The prognostic value of cranial ultrasound and EEG-monitoring for the developmental outcome at 1 year of age in 209 premature and full-term newborns was studied retrospectively. The first ultrasound examination was performed within the first three days of life. Further investigations were done depending on type of severity of the findings. The investigation was completed by EEG-monitoring in 41 patients. The infants were investigated for psychomotor development. 158 infants were found normally developed. Abnormal neonatal ultrasound findings were registered in 18.9% of them. Developmental retardation was observed in 46 infants. 54.3% of them had abnormal ultrasound findings. 2/3 of infants with neonatal major brain insults like IVH III-IV or leukomalacia showed serious neurological handicaps, whereas subependymal bleedings seem to be without influence onto the development. In contrast pathologic EEG's were of higher prognostic value. None of the infants with a abnormal EEG was developed normally.

Parameters for sensitive cerebral monitoring during the neonatal period in intensive care medicine.

In order to bring about further reduction of neonatal mortality and morbidity, immediate and highly sensitive detection of brain-threatening situations is necessary. We investigated 52 newborns by means of 8-channel EEG recorded with normal (15 mm/s) and compressed write-out (1 cm/min). A correct estimation of amplitude of background activity was possible by both methods. For differentiation between healthy newborns and newborns at risk, the right hemisphere amplitude of the interburst period was the most appropriate. The amplitude of the continuous EEG and the interburst period was reduced in the group of newborns at risk. In the group of the most severely disturbed newborns there was an amplitude difference between both hemispheres with greater reduction over the right hemisphere. These results emphasize the importance of the amplitude of background activity for prognostication and the necessity of using 2 interhemispheric derivations for an independent estimation of changes in both hemispheres.

[Autonomic reflexes, EEG and partial arousal reaction in the near-threshold region to acoustic stimuli in the newborn]. / Vegetative Reflexe, EEG und partielle Arousalreaktion im schwellennahen Bereich auf akustische Reize bei Neugeborenen.

A sample of 19 neonates were exposed to sub- and suprathreshold acoustic stimuli. The experiment was performed with sleeping subjects. Stimuli, tones of 125, 250, 500 and 750 cps, third sounds of the same middle frequency and white noise, were applied only, if periods with no REM activity occurred. Stimulus intensity was varied from the subthreshold level (70-80 dB) to the suprathreshold level (80-100 dB). Polygraphic variables were recorded (EEG, EOG, instantaneous heart rate, respiration movements, actogram, motoric reactions and psychogalvanic reflex). The results showed, that with increasing stimulus intensity irregularities of respiratory parameters occurred. With further increase of stimulus intensity systematic changes in respiratory parameters and heart rate occurred. In addition to these changes, EEG activity and motoric reactions were obtained, when stimulus intensity reached a critical level. These data are consistent with the idea that at low stimulus intensities irregular vegetative reactions occur whereas systematic responses can be observed only, if stimulus intensity is above threshold. We conclude that with increasing stimulus intensity subcortical activity decreases whereas cortical activation increases.