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.

Fourteen neonates with posterior mediastinal air collections (retrocardiac pneumomediastinum) are described. In the majority of the infants (13 of 14), the mediastinal air developed as a complication of assisted ventilation. It is suggested that the retrocardiac pneumomediastinum represents air trapped in a potential space in the mediastinum posterior to the heart and not within the pulmonary ligament. The collections have a variable shape and size and rarely may produce a tension phenomenon elevating the posterior, inferior portion of the heart off of the diaphragm. There was a strong association of retrocardiac pneumomediastinum with other manifestations of extraalveolar air, including pulmonary interstitial emphysema (13 of 14 infants), pneumothorax (1 of 14 infants), dissection of air into the soft tissues of the neck (10 of 14 infants), and pneumoperitoneum (5 of 14 infants).