Παιδιατρική | Τόμος 66 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2003

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Τριμηνιαία έκδοση της Ελληνικής Παιδιατρικής Εταιρείας

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<ul><li><p> 2003;66:1 Paediatriki 2003;66:1</p><p>1</p><p>O O O</p><p> , </p><p> , - , . </p><p> , . </p><p> , - , - - . </p><p> O </p><p>JAN-FEB-03 14-05-03 14:37 1</p></li><li><p> 2003;66:2-11 Paediatriki 2003;66:2-11</p><p>2</p><p> . . </p><p>Neurological assessment of the newborn infants M. N. Papadimitriou</p><p>O REVIEW ARTICLE</p><p>: - - . . , - . - Doppler , - , - - . O - - - .</p><p> : , -, , -, . </p><p>Abstract: During the last two decades there hasbeen significant progress in the management ofhigh-risk preterm infants resulting in an increasedsurvival of low-birthweight infants. At the same timemore techniques assessing the neurological wellbeing of these infants have become available.Attention is mainly focused on brain ultrasound,Doppler, MRI, electroencephalography and variousevoked potential modalities. The aim of this study isto illustrate how an integrated approach with thecombined use of imaging and clinical evaluationcan help in predicting neurodevelopmentaloutcomes. </p><p>Key words: newborn infant, electroencephalogra-phy, brain ultrasound, evoked potentials, magne-ticresonance imaging.</p><p> , / . &amp; . , </p><p>Department of Pediatrics, University of Athens P. &amp; A. Kyriakou Childrens Hospital, Athens </p><p> -</p><p> . , - . - - - () (1,2). </p><p> , - ( ) , - , (3,4). </p><p> 50% 25 . 1995 EPICure , </p><p>JAN-FEB-03 14-05-03 14:37 2</p></li><li> 39% </li><li><p> 2003;66:2-11 Paediatriki 2003;66:2-11</p><p>4</p><p> - - (general movements) - , .. - - - (22,23). </p><p> -, 32 (24). , .. -, 34 , - 40 . </p><p> . , 28 -, - (12). - , , -. </p><p> Dubowitz (16) -, . </p><p> - - , .</p><p> - - , - , . </p><p> , - - , ( ).</p><p> 1970</p><p> (sector scanners) 1980 , -, . , , , - . </p><p> - - - (), - (), - . 28 32 (25), - . </p><p> , - Volpe (26) - ( 1). , , (26-28). </p><p> , de Vries(29) ( 2). , . </p><p> 11 , 40 - . , -. - , - 7-10 . </p><p>O - 2-3 , . </p><p> 1. - </p><p> 1. 2. + (10-50% ) 3. + (&gt;50% + ) </p><p>JAN-FEB-03 14-05-03 14:37 4</p></li><li><p> 2003;66:2-11 Paediatriki 2003;66:2-11</p><p>5</p><p> . - 5 z, 7,5 MHz 10 MHz. </p><p> - , - - . </p><p> , - 40 . </p><p> , , ( ) - - . </p><p>, , - - (30). </p><p> - . </p><p> - 1 - ( ) (31). </p><p> 32 - , 75% - 50% (32,33). </p><p>O - - . - ( ) , (34). O (22,34). - - . </p><p> 1 2 . 10% - (35). O - de Vries. (, ) (25,36-39). </p><p> , . , - - , () . </p><p> . - , , , - . , , - . </p><p> (, ) . - - -, invivo. , - (40,41). . </p><p> - -, . , - </p><p> 2. de Vries </p><p> 1. &gt;7 2. 3. 4. , </p><p>JAN-FEB-03 14-05-03 14:37 5</p></li><li><p> 2003;66:2-11 Paediatriki 2003;66:2-11</p><p>6</p><p> - , . </p><p> (18,25,30,42-44). </p><p>, - - , - - . - , , , .. , - . </p><p> (), - , - . - , , - (45). </p><p> , , - , ( ) . , , . 4-6 (45). </p><p> , , - - (44,46). </p><p> (Magnetic resona-nce spectroscopy) </p><p> - . , -, - - -, - </p><p> . O -. </p><p> - (Pcr) (Pi) , (47,48). O , , 24 . -, . - (lactate) - 12-24 - , - (49-51). </p><p>Doppler </p><p> . -. , - , Doppler. </p><p> - , - ( = x). </p><p> , - (Peak systolic velocity,PSV) 3 - (End diastolic velocity, EDV). </p><p>O Pourcelot (the resistance index ofPourcelot, PI) : </p><p> PI 0,65-0,90. </p><p> , - - Pourcelot, . </p><p>O Doppler - - , -, </p><p>PSV-EDV</p><p>PSVPI =</p><p>JAN-FEB-03 14-05-03 14:37 6</p></li><li><p> 2003;66:2-11 Paediatriki 2003;66:2-11</p><p>7</p><p> ( - - ) - ( ) (52). </p><p> Doppler . O Archer, 1986 (53), - 100% 81%, . </p><p>O Levene (54), 1989, 93% 83% . </p><p> , , - 12-24 , , - - 6 (55). </p><p> () (multichannel) </p><p> . . , . - , - artifacts - . , - , (background activity) (56). </p><p> (4 8channels Medilog) - - - , - , - (57). </p><p> - (Medilog System) , , computer, , </p><p> . , , Cerebral Function</p><p>Monitor (CFM, Lectromed), . - 2 -. CFM -, - . </p><p>O CFM, - . , , , 2 - 2 . </p><p> - , , - - . </p><p> 27-28 , (discontinu-ous), (brief bursts) - - . , - (continuous). - (58). - , . . O Wertheim (58), o 1994, - - . </p><p> , -. , - - status epilepticus, . </p><p> (59-62) - -, , </p><p>JAN-FEB-03 14-05-03 14:37 7</p></li><li><p>8 2003;66:2-11 Paediatriki 2003;66:2-11</p><p>, . -</p><p> CFM - . (55,63,64) CFM 6 , - CFM , CFM - . </p><p> - . (56) - , 30-32 , 28-30 -, -. , , . </p><p> (65,66) CFM . CFM . </p><p> (voked potentials) (, -</p><p> ) , . . , , , ., - , - . , - - . </p><p>O (sensorypathways). - , - . </p><p> (Auditory brainstem evoked responses) </p><p> , .. , , -, , , , -, . </p><p> - 40 , ( 36 ), - - (67). - 3 , . </p><p> - - (68,69). </p><p>O (Visual evokedpotentials, VEPs) </p><p> . . - , . , (68). . - -, , , . - (70-73). </p><p> (Somato-sensory evoked potentials, SEPs) </p><p> ( ). , - ( ). - (.. ) (74)., (75,76). </p><p>JAN-FEB-03 14-05-03 14:37 8</p></li><li><p> , - , (77). , 6 , ( ) (71-73). 72 , 93%. - , - , . </p><p> - , - , - 6 . </p><p>, - , CFM SEPs - - - . </p><p> 1. Garland JS, Buck R, Leviton A. Effect of maternal</p><p>glycocorticoid exposure on risk of severe intraventricularhemorrhage in surfactant-treated preterm infants. J Pediatr1995;126:272-279.</p><p>2. Mercier CE, Soll RF. Clinical trials of natural surfactantextract in respiratory distress syndrome. Clin Perinatol1993;91:1083-1088.</p><p>3. LeFlore JL, Salhab WA, Broyles RS, Engle WD. Associationof antenatal and postnatal dexamethasone exposure withoutcomes in extremely low birth weight neonates. Pediatrics2002;110:275-279. </p><p>4. OShea TM, Doyle LW. Perinatal glucocorticoid therapy andneurodevelopmental outcome: an epidemiologicperspective. Semin Neonatol 2001;6:293-307.</p><p>5. Costeloe K, Hennessy E, Gibson AT, Marlow N, WilkinsonAR. The EPICure study: outcomes to discharge fromhospital for infants born at the threshold of viability.Pediatrics 2000;106:659-671.</p><p>6. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR.Neurologic and developmental disability after extremelypreterm birth. N Engl J Med 2000;343:378-384.</p><p>7. Hill ET, den Ouden AL, Bauer L, van den Oudenrijn C,Brand R, Verloove-Vanhorick SP. School performance atnine years of age in very premature and very low birthweight infants: perinatal risk factors and predictors at fiveyears of age. J Pediatr 1994;125:426-434.</p><p>8. Hack M, Wilson-Costello D, Friedman H, Taylor GH,Schluchter M, Fanaroff AA. Neurodevelopment andpredictors of outcomes of children with birth weights of less</p><p>than 1000 g: 1992-1995. Arch Pediatr Adolesc Med2000;154:725-731.</p><p>9. Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, SteichenJJ et al. Neurodevelopmental and functional outcomes ofextremely low birth weight infants in the National Institute ofChild Health and Human Development Neonatal ResearchNetwork, 1993-1994. Pediatrics 2000;105:1216-1226.</p><p>10. Thomas A, Saint-Ann Dargassies S. Etudes neurologic surle nouveau-n et le jeune nourisson. Paris: Masson; 1952. </p><p>11. Thomas A, Chesni Y, Saint-Ann Dargassies S. Neurologicalexamination of the infant. Little Club Clin Dev Med, No 1.London: Medical Advisory Committee of the NationalSpastics Society; 1960.</p><p>12. Saint-Ann Dargassies S. Neurological development in full-term and premature neonate. Amsterdam: ExcerptaMedica; 1977.</p><p>13. Prechtl HFR. The neurological examination of the full-termnewborn infant: a manual for clinical use. 2nd ed. Clin DevMed, No 63. London: SIMP. Philadelphia: HeinemmanMedical; 1977.</p><p>14. Brazelton TB. Neonatal behavioral assessment scale. ClinDev Med, No 50. London: SIMP Heinemann Medical; 1973.</p><p>15. Dubowitz LM, Dubowitz V, Goldberg C. Clinical assessmentof gestational age in the newborn infant. J Pediatr1970;77:1-10.</p><p>16. Dubowitz LMS, Dubowitz V. The neurological assessmentof the preterm and full term newborn infant. Clin Dev MedNo 79. London: SIMP Heinemann Medical. Philadelphia:Lippincott; 1981.</p><p>17. Dubowitz LM, Dubowitz V, Palmer PG, Miller G, Fawer CL,Levene MI. Correlation of neurologic assessment in thepreterm newborn infant with outcome at one year. J Pediatr1984;105:452-456.</p><p>18. Mercuri E, Guzzetta A, Haataja L, Cowan F, Rutherford M,Counsell S et al. Neonatal neurological examination ininfants with hypoxic ischaemic encephalopathy: correlationwith MRI findings. Neuropediatrics 1999;30:83-89.</p><p>19. Dubowitz L, Mercuri E, Dubowitz V. An optimality score forthe neurologic examination of the term newborn. J Pediatr1998;133:406-416.</p><p>20. Frisone MF, Mercuri E, Laroche S, Foglia C, Maalouf EF,Haataja L et al. Prognostic value of the neurologic optimalityscore at 9 and 18 months in preterm infants born before 31weeks gestation. J Pediatr 2002;140:57-60.</p><p>21. Cioni G, Prechtl HF. Preterm and early postterm motorbehavior in low-risk premature infants. Early Hum Dev1990;23:159-191. </p><p>22. Cioni G, Bos AF, Einspieler C, Ferrari F, Martijn A, PaolicelliPB et al. Early neurological signs in preterm infants withunilateral intraparenchymal echodensity. Neuropediatrics2000;31:240-251.</p><p>23. Bos AF, Martijn A, Okken A, Prechtl HF. Quality of generalmovements in preterm infants with transient periventricularechodensities. Acta Paediatr 1998;87:233-234.</p><p>24. Hack M, Mostow A, Miranda SB. Development of attentionin preterm infants. Pediatrics 1976;58:669-674.</p><p>25. Fujimoto S, Togari H, Banno T, Takashima S, Funato M,Yoshioka H et al. Correlation between magnetic resonance</p><p> 2003;66:2-11 Paediatriki 2003;66:2-11</p><p>9</p><p>JAN-FEB-03 14-05-03 14:37 9</p></li><li><p>10</p><p> 2003;66:2-11 Paediatriki 2003;66:2-11</p><p>imaging and clinical profiles of periventricular leukomalacia.Tohoku J Exp Med 1999;188:143-151.</p><p>26. Volpe JJ. Neonatal Neurology. 3rd ed. Philadelphia:Saunders; 1995.</p><p>27. Gould SJ, Howard S, Hope PL, Reynolds EO.Periventricular intraparenchymal cerebral haemorrhage inpreterm infants: the role of venous infarction. J Pathol1987;151:197-202.</p><p>28. de Vries LS, Roelants-van Rijn AM, Rademaker KJ, VanHaastert IC, Beek FJ, Groenendaal F. Unilateralparenchymal haemorrhagic infarction in the preterm infant.Eur J Paediatr Neurol 2001;5:139-149.</p><p>29. de Vries LS, Eken P, Dubowitz LM. The spectrum ofleukomalacia using cranial ultrasound. Behav Brain Res1992;49:1-6.</p><p>30. de Vries LS, Dubowitz LMS, Dubowitz V, Pennock JM. Braindisorders in the newborn. London: Wolfe Medical; 1990.</p><p>31. Roth SC, Baudin J, Pezzani-Goldsmith M, Townsend J,Reynolds EO, Stewart AL. Relation betweenneurodevelopmental status of very preterm infants at oneand eight years. Dev Med Child Neurol 1994;36:1049-1062.</p><p>32. Randomised trial of early tapping in neonatalposthaemorrhagic ventricular dilatation. VentriculomegalyTrial Group. Arch Dis Child 1990;65:3-10.</p><p>33. Fernell E, Hagberg G, Hagberg B. Infantile hydrocephalusin preterm, low-birth-weight infants: a nationwide Swedishcohort study 1979-1988. Acta Paediatr 1993;82:45-48. </p><p>34. Blackman JA, McGuinness GA, Bale JF Jr, Smith WL Jr.Large postnatally acquired porencephalic cysts:unexpected developmental outcomes. J Clin Neurol1991;6:58-64. </p><p>35. de Vries LS, Eken P, Groenendaal F, van Haastert IC,Meiners LC. Correlation between the degree ofperiventricular leukomalacia diagnosed using cranialultrasound and MRI later in infancy in children with cerebralpalsy. Neuropediatrics 1993;24:263-268.</p><p>36. Fazzi E, Orcesi S, Caffi L, Ometto A, Rondini G, Telesca Cet al. Neurodevelopmental outcome at 5-7 years in preterminfants with periventricular leukomalacia. Neuropediatrics1994;25:134-139. </p><p>37. Rogers B, Msall M, Owens T, Guernsey K, Brody A, Buck Get al. Cystic periventricular leukomalacia and type ofcerebral palsy in preterm infants. J Pediatr 1994;125:S1-8.</p><p>38. Cioni G, Fazzi B, Ipata AE, Canapicchi R, van Hof-van DuinJ. Correlation between cerebral visual impairment and MRimaging in children with neonatal encephalopathy. DevMed Child Neurol 1996;38:120-132.</p><p>39. Pierrat V, Duquennoy C, van Haastert IC, Ernst M, Guilley N,de Vries LS. Ultrasound diagnosis and neurodevelopmentaloutcome of localised and extensive cystic periventricularleukomalacia. Arch Dis Child Fetal Neonatal Ed2001;84:F151-F156. </p><p>40. Dubowitz LM, Bydder GM. Nuclear magnetic resonanceimaging in the diagnosis and follow-up of neonatal cerebralinjury. Clin Perinatol 1985;12:243-260.</p><p>41. Dubowitz LM, Bydder GM, Mushin J. Developmentalsequence of periventricular leukomalacia. Correlation ofultrasound, clinical, and nuclear magnetic resonancefunctions. Arch Dis Child 1985;60:349-355.</p><p>42. Rutherford MA, Pennock JM, Dubowitz LM. Cranialultrasound and magnetic resonance imaging in hypoxic-ischaemic encephalopathy: a comparison with outcome.Dev Med Child Neurol 1994;36:813-825.</p><p>43. Rutherford MA, Pennock JM, Counsell SJ, Mercuri E,Cowan FM, Dubowitz LM et al. Abnormal magneticresonance signal in the internal capsule predicts poorneurodevelopmental outcome in infants with hypoxic-ischaemic encephalopathy. Pediatrics 1998;102:323-328.</p><p>44. de Vries LS, Groenendaal F, van Haastert IC, Eken P,Rademaker KJ, Meiners LC. Asymmetrical myelination ofthe posterior limb of the internal capsule in infants withperiventricular haemorrhagic infarction: an early predictor ofhemiplegia. Neuropediatrics 1999;30:314-319.</p><p>45. Dubowitz LM, Cowan F, Rutherford M, Mercuri E, PennockJ. Neonatal neurology, past present and future. A windowon the brain. Brain Dev 1995;17 (Suppl):22-30.</p><p>46. Mercuri E, Rutherford M, Cowan F, Pennock J, Counsell S,Papadimitriou M et al. Early prognostic indicators ofoutcome in infants with neonatal cerebral infarction: ac...</p></li></ul>

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