The predictive value of cranial ultrasound and of somatosensory evoked potentials after nerve stimulation for adverse neurological outcome in preterm infants

Pierrat, Véronique; Eken, P.; Vries, LS de

doi:10.1111/j.1469-8749.1997.tb07453.x

Cited by 24 publications

(29 citation statements)

References 24 publications

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“…All studies except one were based at tertiary neonatal units. Three studies reporting a high prevalence of CP were included and were explainable by biased population selection from high‐risk groups …”

Section: Resultsmentioning

confidence: 99%

A systematic review of tests to predict cerebral palsy in young children

Bosanquet

Copeland

Ware

et al. 2013

Develop Med Child Neuro

406

424

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CUSCranial ultrasound GMA General movements assessment IVH Intraventricular haemorrhage STARD Standards for Reporting Diagnostic Accuracy AIM This systematic review evaluates the accuracy of predictive assessments and investigations used to assist in the diagnosis of cerebral palsy (CP) in preschool-age children (<5y).METHOD Six databases were searched for studies that included a diagnosis of CP validated after 2 years of age. The validity of the studies meeting the criteria was evaluated using the Standards for Reporting Diagnostic Accuracy criteria. Where possible, results were pooled and a meta-analysis was undertaken.RESULTS Nineteen out of 351 studies met the full inclusion criteria, including studies of general movements assessment (GMA), cranial ultrasound, brain magnetic resonance imaging (MRI), and neurological examination. All studies assessed high-risk populations including preterm (gestational range 23-41wks) and low-birthweight infants (range 500-4350g). Summary estimates of sensitivity and specificity of GMA were 98% (95% confidence interval [CI] 74-100%) and 91% (95% CI 83-93%) respectively; of cranial ultrasound 74% (95% CI 63-83%) and 92% (95% CI 81-96%) respectively; and of neurological examination 88% (95% CI 55-97%) and 87% (95% CI 57-97%) respectively. MRI performed at term corrected age (in preterm infants) appeared to be a strong predictor of CP, with sensitivity ranging in individual studies from 86 to 100% and specificity ranging from 89 to 97% There was inadequate evidence for the use of other predictive tools.SUMMARY This review found that the assessment with the best evidence and strength for predictive accuracy is the GMA. MRI has a good predictive value when performed at termcorrected age. Cranial ultrasound is as specific as MRI and has the advantage of being readily available at the bedside. Studies to date have focused on high-risk infants. The accuracy of these tests in low-risk infants remains unclear and requires further research.Cerebral palsy (CP) occurs in 1 to 3% of live-born infants. 1-3 This increases to 8 to 40% in high-risk populations such as extremely preterm infants. 4 CP is an umbrella term for conditions that are characterized by a nonprogressive, but not unchanging, motor impairment related to brain injury early in development.5-7 The brain injury is characteristically static and results in activity limitation. 7Given the diversity of the clinical picture and implications on management, CP is a diagnosis that is further described by motor type, distribution, functional severity, and comorbidities. 8 Metabolic, syndromic, and genetic conditions that appear similar to CP may present in early life, with a picture of motor impairment. Differentiating these from CP early on has genetic and treatment implications.8 When CP is diagnosed early, surveillance programmes for musculoskeletal and other comorbidities can be instigated and early intervention programmes initiated.9-11 From the child and family's perspective, receiving a diagnosis of CP not only provides 'an answ...

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Section: Resultsmentioning

confidence: 99%

A systematic review of tests to predict cerebral palsy in young children

Bosanquet

Copeland

Ware

et al. 2013

Develop Med Child Neuro

406

424

View full text Add to dashboard Cite

show abstract

“…Possible injury to the thalamo-cortical connections due to periventricular pathology has also motivated a wealth of SEP studies in preterm infants to assess the predictive value of abnormal (absent or delayed depending on the study) median nerve sep MN 30 (usually referred to as N1 in the literature; Klimach and Cooke, 1988b; Willis et al, 1989; de Vries et al, 1992; Pierrat et al, 1997) and the earliest posterior tibial nerve SEP (referred to as P1) from SI for future cerebral palsy (CP) (White and Cooke, 1994; Pierrat et al, 1997; Pike and Marlow, 2000). Results have been, however, somewhat contradictory, with specificity, sensitivity, and positive and negative predictive values varying markedly between studies.…”

Section: Early Brain Insults and Somatosensory System Developmentmentioning

confidence: 99%

Development of Human Somatosensory Cortical Functions â€“ What have We Learned from Magnetoencephalography: A Review

Nevalainen

Lauronen

Pihko

2014

Front. Hum. Neurosci.

106

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The mysteries of early development of cortical processing in humans have started to unravel with the help of new non-invasive brain research tools like multichannel magnetoencephalography (MEG). In this review, we evaluate, within a wider neuroscientific and clinical context, the value of MEG in studying normal and disturbed functional development of the human somatosensory system. The combination of excellent temporal resolution and good localization accuracy provided by MEG has, in the case of somatosensory studies, enabled the differentiation of activation patterns from the newborn’s primary (SI) and secondary somatosensory (SII) areas. Furthermore, MEG has shown that the functioning of both SI and SII in newborns has particular immature features in comparison with adults. In extremely preterm infants, the neonatal MEG response from SII also seems to potentially predict developmental outcome: those lacking SII responses at term show worse motor performance at age 2 years than those with normal SII responses at term. In older children with unilateral early brain lesions, bilateral alterations in somatosensory cortical activation detected in MEG imply that the impact of a localized insult may have an unexpectedly wide effect on cortical somatosensory networks. The achievements over the last decade show that MEG provides a unique approach for studying the development of the somatosensory system and its disturbances in childhood. MEG well complements other neuroimaging methods in studies of cortical processes in the developing brain.

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“…In preterm infants, both median nerve and posterior tibial nerve SEPs have been evaluated for their value in predicting future cerebral palsy (CP). The sensitivity of abnormal median-nerve SEPs to predict CP has ranged from 13 to 100%, with a specificity of 87-100% (Klimach and Cooke, 1988b;Willis et al, 1989;Majnemer et al, 1990;De Vries et al, 1992;Pierrat et al, 1997), whereas respective values for abnormal tibial nerve SEPs have been 63-96% for sensitivity and 50-99% for specificity (White and Cooke, 1994;Pierrat et al, 1997;Pike and Marlow, 2000). Many SEP studies have experienced technical difficulties in reliably recording the responses, particularly in the youngest preterm infants (Klimach and Cooke, 1988a;Smit et al, 1998Smit et al, , 2000.…”

Section: Introductionmentioning

confidence: 97%