SUMMARY Thirteen preterm children, aged 4 to 14 years, with visual impairment due to periventricular leukomalacia (PVL) were evaluated for visual function, intellectual level, cognitive profile and motor function. Their visual impairment was characterized by low acuity, crowding, visual field defects and ocular motility disturbances. Their cognitive profile was uneven, often with considerably higher scores on verbal than on visual‐spatial tasks. Nine children had normal intelligence, three had mild mental retardation and one had severe mental retardation. In all the children, visual impairment was complicated by visual perceptual difficulties, accounting for their greater visual handicap than would be expected from their visual acuities and strabismus alone. Though CT or MRI revealed bilateral PVL in all the children, six had no motor impairment consistent with cerebral palsy, which is an unexpected finding. RÉSUMÉ Troubles visuels chez le prématuré avec leacomalacie péri‐ventriculaire‐caractéristiques visuelles, cognitives el neuropédiatriques reliees àľimagerie cérébrale Une évaluation de la fonction visuelle, du niveau intellectuel, du profit cognitif et de la fonction motrice, a été effectuée chez treize prématurés âgés de 4 à 14 ans et présentant un trouble visuel liéà une leucomalacie périventriculaire (PVL). Le trouble visuel était caractérisé par une baisse de ľacuité, un décrochage du suivi, des défauts du champ visuel et des troubles de la motilité oculaire. Leur profil cognitif était dysharmonieux avec souvent des scores considérablement plus cleves aux taches verbales qu'aux taches visuo‐spatiales. Neuf enfants avaient une intelligence normale, trois un retard mental leger et un, un retard mental sévère. Chez tous les enfants, le trouble visuel était compliqué par des difficultés visuo‐perceptives, rendant compte ďun plus fort handicap visuel qu'on aurait pu attendre de leur acuité visuelle et du strabisme seuls. Bien que le scanner ct ľIRM. montraient une PVL bilatérale chez tous les enfants, six ne présentaient pas de déficit moteur de type IMC, ce qui est une découverte inattcndue. ZUSAMMENFASSUNG Visuelle Störungen bei Frühgeborenen mit perivenrikulärer Leukomalazie ‐ visuelle, kognitive und neuropädiatrisclie Clwrakleristika in. Relation zu CT und MRT Befunden Bei 13 Frühgeborenen mit visuellen Störungen aufgrund einer periventrikulären Leukomalazie (PVL) wurden im Alter von 4 bis 14 Jahren Sehfunktion, Intelligenzgrad, Wahrnehmungsprofil und Motorfunktion untersucht. Ihre visuelle Stöning war charakterisiert durch gcringe Sehschärfe, Crowding, Gesichtsfeldeinschränkungen und Augenmotilitätsstörungen. Ihr Wahnehmungsprofil war unterschiedlich, häufig mit erhcblich höheren Scores bei den verbalen als bei den visucllräumlichen Aufgaben. Neun hatten eine normale Intelligenz, drei warcn leicht retardiert und eins hatte eine schwere geistige Behinderung. Bei allen Kindern war die visuelle Befund durch eine visuelle Perzeptionsstörung kompliziert. die für ihre größere visuelle Behinderung verantwortlic...
ABSTRACT.Purpose: The aim of the study was to evaluate possible neonatal risk factors for retinopathy of prematurity (ROP) in a population-based group of preterm, very low birth weight, infants. Method: The main study group included 202 single-born infants with a birth weight of 1500 grams or less. A group of 57 twins were also described. Selected risk factors were extracted from the neonatal records. Results: Univariate analysis revealed an association between ROP and respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), septicaemia, intraventricular bleeding, and the use of ventilator as well as continuous positive airway pressure. In a stepwise logistic regression analysis, however, only gestational age at birth, birth weight and BPD were significantly associated with ROP. Conclusion: Prematurity per se remains the strongest risk factor for ROP.Key words: retinopathy of prematurity -risk factors -gestational age -birth weight -bronchopulmonary dysplasia.
Jdnsson B, Katz-Salamon M, Faxelius G, Broberger U, Lagercrantz H. Neonatal care of very-lowbirthweight infants in special-care units and neonatal intensive-care units in Stockholm. Early nasal continuous positive airway pressure versus mechanical ventilation: gains and losses. Acta Paediatr 1997; Suppl419: 4-10. Stockholm. ISSN 0803-5326.Very-low-birthweight (VLBW) infants are usually intubated at birth and mechanically ventilated at neonatal intensive-care units (NICUs). The objectives of this study were to evaluate the use of early nasal continuous positive airway pressure (NCPAP) in a regional cohort and to determine to what extent VLBW infants need transfer to a regional NICU from special-care units (SCUs) that primarily use early NCPAP for respiratory care. We compared the outcome for infants at SCUs and NICUs in Stockholm County, Sweden, from 1988 to 1993. All infants with birthweights of less than 1501 g were included in this study (n = 687). Fifty-nine per cent of the infants (400/687) were supported using only supplemental oxygen or NCPAP. Of these, 170 (25%) received only supplemental oxygen and 230 (34%) were supported only by NCPAP. A total of 350 (5 1%) infants received early NCPAP. Of these infants, 120 (34%) later required mechanical ventilation. Only 167 (24%) infants received mechanical ventilation from the beginning. Failure of NCPAP was significantly associated with the presence of respiratory distress syndrome. A total of 161/412 (39%) infants were transferred from SCUs to NICUs. Of infants =s 26 weeks' gestation and infants > 26 weeks, 71% and 34% were transferred, respectively. Total mortality was 16%. The mortality for transfers was 20% compared to an overall mortality in SCU and NICU infants of 9% and 15%, respectively. The overall incidence of intraventricular haemorrhage (IVH), grade 111-IV was 8%, perivenmcular leucomalacia (PVL) grade I-IV was 7%, retinopathy of prematurity (ROP) requiring cryotherapy was 4.3% and chronic lung disease (CLD) was 14%. There were significant differences in the incidence of IVH, PVL, CLD and ROP between SCU and NICU infants in matched gestational age groups. In conclusion, infants with a gestational age of 27 weeks or more may often be adequately cared for at SCUs without mechanical ventilation by using early NCPAP. However, infants with a gestational age of 26 weeks or less should be transferred to tertiary-care centres preferably before birth, because they will often require mechanical ventilation. 0 Continuous positive airway pressure, mechanical ventilation, pretenn infants H Lagercrantz,
Prematurity per se remains the strongest risk factor for ROP.
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