No abstract

The purpose of this study was to determine the diagnostic accuracy of a neurological assessment performed before discharge from the nursery to predict cerebral palsy at three years of age in preterm infants. Infants born < 31 weeks gestation between 1992 and 1996 were assessed using the Lacey Assessment of the Preterm Infant (LAPI) prior to discharge. Infants were classified as having no abnormality, possible abnormality, or definite abnormality. At three years of age, the infants had a neurological examination. Infants were stratified into those assessed at < or = 33 weeks postmenstrual age and those assessed at least once > 33 weeks postmenstrual age. Of the 203 infants, 36 were diagnosed with cerebral palsy at three years. Seven were assessed < or = 33 postmenstrual age and 29 were assessed > 33 weeks postmenstrual age. For infants assessed < or = 33 weeks and classified as having any abnormality (possible or definite), the LAPI had 86% sensitivity, 83% specificity, and 96% negative predictive value for subsequent cerebral palsy. The LAPI was less accurate when applied to infants < 33 weeks postmenstrual age. The LAPI is an accurate diagnostic tool in the preterm period for the prediction of normal motor development or cerebral palsy at three years of age. This information may be used to target intervention.

SUMMARY The incidence, duration, and type of apnoea were determined in 28 preterm infants born at 27 to 34 weeks' gestation, using polygraphic records of abdominal breathing movements and nasal airflow. Of the 1520 episodes of apnoea of 10 or more seconds duration, 1002 (66%) lasted 10 to 14 seconds, 311 (20%) lasted 15 to 20 seconds, and 207 (14%) lasted more than 20 seconds. Overall, 69% were central in type, 20% were mixed, and 11% were purely obstructive. With increasing duration of apnoea, the proportion of episodes of central apnoea decreased (69 to 29%) while that of mixed apnoea increased (20 to 60%). Eight infants had obstructive apnoea of more than 20 seconds duration. When they were compared with the 10 infants of similar gestational age and birthweight who had central or mixed apnoea, they had a higher incidence of intraventricular haemorrhage, hydrocephalus, positive pressure ventilation via an endotracheal tube, and abnormal neurological development during the first year of life.

We could find no evidence that chest physiotherapy, as given in our unit, was associated with abnormal neurological outcomes in extremely preterm infants.

Clinical techniques and protocols for chest physiotherapy vary greatly from one Neonatal Intensive Care Unit to another. In 1988 a questionnaire designed to investigate differing techniques used was distributed to Neonatal Intensive Care Units (NICU) around Australia. Fourteen of the 15 questionnaires were completed and returned. The results revealed that the methods of chest treatment and the indicators for commencing chest treatment were similar throughout NICU. Both physiotherapists and nursing staff played a role in the performance of chest treatment in all but one unit where it was the responsibility of nursing staff. However, the area in which there was most variability between NICU was the individual treatment protocols employed pre- and postextubation of the neonate. A review of literature over the past 10 years also demonstrates variability in chest physiotherapy. It was concluded that further well-controlled studies with larger sample sizes are needed to validate the use of chest physiotherapy for the neonate, especially in relation to the techniques and specific protocols employed.

No abstract

The most common complication (8.8%) was pathological fracture. The fracture involved the shaft of the femur in 62%, occurring in this section of the bone almost seven times more frequently in the patients with Paget's disease than in the general population.Because of the large number of undiagnosed cases in the community, the true incidence of pathological fracture and of sarcoma of bone in all patients with Paget's disease is probably only 1% and 0-1% respectively.Simultaneous estimates of the serum alkaline phosphatase and ESR were made in 128 ofthe patients.It was shown that the ESR is valueless as a measure of activity or extent of the disease.In many patients the level of the serum alkaline phosphatase changed very little over periods of several years.A history of the disease in one or more close relatives was found in three families, a lower incidence than was expected from previously recorded studies. The ABO blood groups were determined in 215 of the patients; 50% were of group A compared with 46% in a control group. The difference in distribution of blood groups in the two series of subjects is small and well within chance limits. The secretor status of 138 patients was investigated; 77% were secretors. This is similar to the DroDortion in control series.

One hundred and fifty-three infants were assessed by a method specitlc to preterm infants and appropriate to the intensive-care nursery environment. The presence or absence of six atypical features (coarse jitters. dominant asymmetrical tonic neck reflex, paucity of movement, 'contradictory' development, hypotonia, or hypertonia) resulted in neonatal classi5cation. There were 116 'usual' (an absence of atypical features with progressive development), 26 'unusual' (a transient occurrence of any atypical feature), and 11 'suspect' (dominance of one or more atypical features). At 6 years of age the motor subsystems of balance, cgordination, fine and gross motor, and associated movements were assessed. Nine of il children with cerebral palsy had neonatal categories of 'suspect' (7) and 'unusual' (2). of the remaining four other 'suswct' children, two failed two motor subsystems and two failed motor items. A 'usual' neonatal assessment predicted normal motor outcome for 7!2 of 116 (82%) whereas a 'suspect' assessment predicted major motor dysfunction for seven of 11 of the children. INeonatal intensive-care nurseries are witnessing a marked increase in the survival rate of infants born at very low gestational age and discharge before term-equivalent age. There is no published neurological assessment method specifically for these immature infants that is appropriate for thc intensivc-care nursery during the pretcnn period. Methods standardized for term infants, or both preterm and term infants, are still used for neurological assessment at term-equivalent agc, despite early studies that have highlighted the differences between the preterm and t e k infants: Kurtzbcrget al. This paper compares the neurological ;issessments at prcterm age with 6-year outcomes to evaluate two hypotheses: (1) preterm infants who demonstrate 'usual' development of posture and movement on the longitudinal assessment during the preterm period have normal motor outcome at 6 years; and (2) pretenn infants who repeatedly show one or more atypical features during the preterm assessment have abnormal motor outcomc at 6 years. Xethod S'I urn POPlrIA,lIONThe subjects of the study are prematurely born children who undenvent a longitudinal assessment at preterm age (see below) and whose parents consented to a Winded' followup study when the children were 6 years old. The infants were all nursed in the intensive-care nursery at King George V Hospital. Sydney, Australia between 1982 and 1984. Infants with a known gestational age of 5 34 w e c h and/or a binhweight of <2000g or < 10th centile weight for gestational age, and who were without congcnital anomalies were eligible for enrolment in this prospective study ( N = 3 0 3 ) .Subjects should have had three or more examinations in the neonatal period, but were excluded if 13 examinations were completed. Four study chil+n died: one with pulmonary atresia; one from a motor vehicle accident; and two from sudden infant death syndrome. The neonatal classifications o f the latter two were 'unusual' and 'sus...