In this study, the diagnostic and predictive value of brainstem, middle latency, and cortical auditory evoked responses (BMC-AERs) obtained in the neonatal period in 81 preterm infants was assessed in relation to neurodevelopmental outcome. The preterm infants were neonatally classified according to risk category and gestational age. The BMC-AERs were analyzed with respect to detectability, latencies, and amplitudes as well as derived latency and amplitude measures. At 5 y of age the neurodevelopmental outcome was assessed from neurologic and neuropsychologic evaluations. The results showed that BMC-AER differences mainly correlated with risk category (low risk/high risk) and to some extent with degree of prematurity. In view of these findings the degree of prematurity and the effect of risk category have to be taken into account, when BMC-AERs are applied in the preterm period to predict neurodevelopmental outcome. In this study the BMC-AERs for infants with abnormal neurodevelopmental outcome were scarcely distinguishable from the BMC-AERs for infants with normal neurodevelopmental outcome. Thus far, this and previous reports have indicated that BMC-AERs in preterm infants are useful in maturational studies and with infants showing symptoms related to lesions or dysfunction of the peripheral and/or central auditory system. For predicting neurodevelopmental outcome in preterm infants, BMC-AERs are of limited clinical value.
This study shows that IVH, bilirubin and assisted ventilation contribute most to the validity and predictive value of the NBRS. Furthermore, regarding neurological outcome addition of a GAF in combination with an AERF resulted in a substantial improvement of the validity and predictive value. The shortcomings of the current neonatal risk scores require a careful interpretation of clinical perinatal data regarding the prediction of neurodevelopmental outcome in preterm infants.
The diagnostic and predictive value of brainstem, middle latency, and cortical auditory evoked responses, obtained in the neonatal period, in 81 preterm infants was assessed in relation to neurodevelopmental outcome. Eighteen healthy term infants served as a control group. In this report the patient characteristics and neurodevelopmental outcome are presented. The preterm infants were neonatally classified according to risk category and gestational age. At 5 y of age the neurodevelopmental outcome was assessed based on neurologic and neuropsychologic evaluations. The neuropsychologic test results showed the highest IQ scores in term infants, intermediate IQ scores in low risk preterm infants, and lowest IQ scores in high risk preterm infants. The intermediate IQ scores in the low risk preterm group were due to significantly lower test scores in a small subgroup of low risk preterm infants. In a post hoc analysis 12 low risk preterm infants with an unfavorable outcome could be identified. The neuropsychologic test results of the remaining low risk infants showed no clear differences compared with the term infants. The results suggest that the unfavorable outcome of the low risk preterm group as a whole is due to moderate to severe impairment of the few, rather than slight impairment of the majority.
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