Clinical aspects of neurological disorders in premature infants [ASPETTI CLINICI DELLA SOFFERENZA NEUROLOGICA DEL PREMATURO]

Clinical aspects of brain neonatal disorders (b.n.d.) in premature infants were not carefully investigated up to now; this chiefly depended on the fact that, prior to the availability of computed tomography, it was not possible to document the presence of intracranial lesions in living infants, so that the clinical diagnosis of b.n.d. in prematures was often missed. Recent study by Papile et al. with CAT scan proved that nearly 50% of all infants with 1,500 gm body wt in a neonatal intensive care unit have periventricular hemorrhage. Tsiantos et al., using the isotope technique, demonstrated that the bleeding of intraventricular hemorrhage occurs generally during the 2nd or 3rd day of life, and that a secondary infarction and bleeding after some days occurs in a susceptible group of prematures. Clinical symptoms of b.n.d. usually manifest on the 3rd or 4th day of life; the course of b.n.d. in premature infants may be acute and progressive, or subacute, and may present one or more unexpected relapses after some hours or days. The clinical picture of b.n.d. is more aspecific in regard to the etiology, to the location, the level and the extent of the brain injury, the shorter the gestational age of the baby; part of the infants with intracranial hemorrhage or CNS infections are free of clear neurological signs. Besides, extent of brain lesions does not closely correlate with the severity of the symptoms. The identification of the premature infants with b.n.d. and the discrimination of the severity of the brain damage is therefore difficult in most cases by the clinical examination only. Volpe nevertheless recommends to look much more closely at the neurological signs in such infants. He distinguishes 2 different syndromes: a catastrophic one, frequently fatal, and a saltatory one, more subtle in presentation and more favorable as the prognosis is concerned. 2 Other pictures were observed in the authors experience: a fulminant one, leading to death in a few minutes with the characters of collapse, and a 2nd one with repetitive apneas, depression of consciousness and spontaneous motility, hypotonia alternating with iperexcitability and dispnea. At present, the identification of bnd and of the severity of the corresponding brain damage in premature infants may be performed on the basis of instrumental techniques such as EEG polygraphic records, ultrasound scanning of brain and CAT scan. Serial CAT scans also permit to follow the evolution of the brain lesions and suggests early surgical treatment in cases of posthemorrhagic progressive hydrocephalus.