Neonatal neurological examination in well newborn term Ugandan infants.

BACKGROUND: Newborn neurological examinations have mostly been developed in high-resource settings with cohorts comprising predominantly white Caucasian infants. No comparison has been made with different populations. AIMS: To (i) establish the range of neurological findings in apparently well newborn term Ugandan infants, (ii) compare these findings to published data for equivalent term UK infants and (iii) correlate the neurological findings with perinatal characteristics and cranial ultrasound (cUS) imaging. METHODS: Low-risk term Ugandan infants were recruited from the postnatal ward at Mulago Hospital, Kampala, Uganda. Neurological examination (1) and cUS were performed. The raw data and neurological optimality scores were compared to published data from UK infants (1). Gestational age, postnatal age, sex, maternal parity and HIV status, mode of delivery, birth weight and head circumference were correlated with raw scores. RESULTS: Ugandan infants showed significantly stronger palmar grasp, better auditory and visual orientation, less irritability and less need for consoling but had poorer tone, poorer quality of spontaneous movements and more abnormal signs than UK infants. No correlation was found between raw scores and cUS findings, gestational age, sex, birth weight and head circumference. Significantly fewer Ugandan infants had optimal scores based on the UK data. CONCLUSION: The neurological status of low-risk hospital-born term Ugandan infants differs from that of low-risk UK infants. The study findings have implications for assessing normality in Ugandan infants and raise concerns about the use of this UK "optimality" score in other research settings. Further work is needed to understand fully the reasons for the differences.

Cerebral measurements made using cranial ultrasound in term Ugandan newborns.

BACKGROUND: Few cUS studies of cerebral measurements are available for normal term infants. Normative data is important for evaluating cerebral structure size in symptomatic term infants and assessing preterm brain growth by term age. OBJECTIVES: To (i) make linear measurements using cranial ultrasound (cUS) for major cerebral structures and intracranial spaces in normal newborn term infants, (ii) correlate these measurements with gestational age (GA), birth weight (BW), head circumference (HC), gender and within one infant (iii) examine inter/intra-observer variation, and (iv) compare these data with those currently available. DESIGN, SETTING AND PATIENTS: Linear cUS measurements of major cerebral structures were made in well term-born Ugandan infants at Mulago University Hospital, Kampala. Correlations between the measurements and gender, HC, BW and GA were calculated. Intra- and inter-observer agreements were assessed. RESULTS: Data from 106 infants (mean GA 39.20±1.4SD weeks) were analysed. Intra/inter-observer agreement was substantial/excellent. Significant correlations were found between HC and pons anterior-posterior diameter (p<0.01), corpus callosal (CC) length (p=0.02) and transverse cerebellar diameter (TCD, p<0.01) and between BW and CC length (p=0.02), vermis height (<0.01) and thalamo-occipital distance (p=0.03); no significant correlation was found with GA. Within infants CC length and TCD correlated significantly (p=0.019). Males had larger left ventricular indices than females (p=0.04). The data was similar to those from other populations. CONCLUSIONS: These data provide reliable reference values for linear measurements of many cerebral structures made using cUS. The data agree well with those from other populations suggesting that cerebral size is similar in different ethnic groups.

Cranial ultrasound findings in well newborn Ugandan infants.

BACKGROUND: There has been no study assessing cranial ultrasound (cUS) scans in newborn infants born in equatorial Africa. OBJECTIVE: To assess the cUS scans of apparently well newborn term Ugandan infants and to correlate the findings with perinatal data. METHODS: An observational study of apparently healthy postnatal ward term Ugandan infants at Mulago Hospital, Makerere University Hospital, Kampala, Uganda. RESULTS: Data from 112 infants scanned at a median age of 1.4 postnatal days were analysed. Only 57 (51%) infants had scans considered normal, including 30 infants with isolated focal peritrigonal white matter (WM) echogenicity that was very common, occurring in 60 (53%) of infants. More extensive WM echogencities were seen in nine (7.5%) and focal unilateral central grey matter echogenicity in eight (6.5%) infants. Haemorrhage was not common. Subependymal pseudocysts (SEP) and choroid plexus cysts (CPC) occurred in 19.6% of infants each. Four infants only had lenticulostriate vasculopathy. No correlation was found between mode of delivery, birth weight, head circumference or gestational age, maternal HIV status and any cUS abnormality. CONCLUSIONS: Apparently well term-born Ugandan infants frequently have abnormalities on cUS. These are mainly increased WM echogenicity, SEP and CPC. These may relate to the reported high incidence of congenital infections in this population but this remains to be confirmed. The observations provide baseline data for comparison with scans from sick infants from similar communities and are also important for studies in which cUS will be used to assess progress.