ABSTRACT
The neurodevelopmental outcome of premature infants with persistent apnea of prematurity (AOP) is reported. Sixty premature infants (birthweight [BW], 1469 +/- 533 gm; gestational age [GA , 31 +/- 3 weeks) with AOP were compared to 47 control infants (BW, 1586 +/- 581 gm; GA, 31 +/- 3 weeks) matched for gestational age and degree of neonatal illness. The infants were enrolled in a multidisciplinary follow-up program, and outcome data between 12 and 24 months are reported. Assessments included the Bayley Scores of Infant Development, neurologic examinations, speech and hearing examinations. There were no significant differences in the cognitive outcome between the premature infants with AOP and the premature control group. In 50 of 60 infants the Bayley Mental Developmental Index was in the normal range (112 +/- 18) as was 39 of 47 of the control group (112 +/- 13). Delays in motor development were seen in both premature groups, although a greater percentage of premature infants with persistent apnea had mild motor delays than did control infants. There was a comparable incidence of cerebral palsy (8% vs 11%), speech delays (20% vs 23%), retinopathy (8% vs 13%), and esotropia (7% vs 4%) between the infants with AOP and the premature control infants. The presence of persistent neonatal apnea without additional adverse perinatal events did not appear to be associated with a higher incidence of significant developmental problems.
Subject(s)
Apnea/epidemiology , Cerebral Palsy/epidemiology , Developmental Disabilities/epidemiology , Infant, Premature, Diseases/epidemiology , Infant, Premature/growth & development , Apnea/complications , Cerebral Palsy/diagnosis , Child, Preschool , Developmental Disabilities/diagnosis , Female , Follow-Up Studies , Humans , Incidence , Infant , Infant, Newborn , MaleABSTRACT
Current methods of cerebral blood flow (CBF) determination provide only discrete, episodic data and are limited in assessing dynamic changes in cerebral circulation. We adapted a venous outflow technique employing cannulation of the superior sagittal sinus in newborn puppies to measure changes in CBF rapidly and sequentially during ventilatory maneuvers. CBF velocity (CBFV) was measured simultaneously with Doppler ultrasound of the anterior cerebral artery. Relationships between flow and velocity were determined during hypocarbia, hypercarbia, hypoxia and asphyxia. During hyperventilation, CBF decreased by a mean of 14%, and CBFV by 13%, whereas maximal CO2 inhalation increased CBF by 59% and CBFV by 110%. Although CBFV exhibited the same directional changes as shown by the area under the velocity curve, the magnitude of change was not proportional to flow. CBFV indicated trends in the direction of changes in flow in individual animals, but did not correlate with flow between animals. A fluctuating unstable pattern of CBFV, previously associated with neonatal intracranial hemorrhage, was demonstrated with hyperventilation and hypocarbia. During asphyxia, CBFV ceased 2-5 min prior to CBF, presumably reflecting continued brain perfusion from vessels other than anterior cerebral artery.
Subject(s)
Animals, Newborn/physiology , Cerebrovascular Circulation , Animals , Asphyxia/physiopathology , Blood Flow Velocity , Carbon Dioxide/metabolism , Dogs , Hyperventilation/physiopathologyABSTRACT
The neurodevelopmental outcome of term infants with acute life-threatening events (ALTE) and preterm infants with persistent apnea of prematurity were compared to matched control populations. No differences in developmental outcomes were seen between the study and control populations.
