Neurological development in very-low-birthweight infants. Application of a standardized examination and Prechtl's optimality concept in routine evaluations.

Modern methods of newborn intensive care have greatly improved long-term morbidity rates of very-low-birthweight (VLBW) infants. Our standardized neurological examination was applied to 3- and 6-month-old infants and expressed as a score by using Prechtl's optimality concept. Among 98 VLBW infants, 56 were at high risk because of perinatal complications with possible cerebral distress and 42 had no complications. The VLBW infants were also divided into AGA (61) and SGA (37) babies. In addition, 29 full-term infants were enrolled as controls. A statistical analysis of the optimality scores revealed that all VLBW infants had significantly lower mean scores at the corrected age of 3 months than the full-term controls. Intrauterine growth retardation and perinatal cerebral distress clearly depress the optimality scores. At 6 months only infants with high perinatal risk had considerably lower scores than the age controls. Two-thirds of all VLBW infants were found to have a developmental delay and/or a neurological deficit at the corrected age of 3 months. At age 6 months, however, a marked catch-up and/or self-repair had occurred, as was documented by about 70% of normal optimality scores. Head circumference measurements over the first year of life can be an important assisting factor in developmental assessments. If a microcephalic infant does not show higher than normal head growth velocity a severe developmental delay or neurological deficit must be expected. At 12 months the Bayley scores of psychomotor development have served to complement the preceding neurological and head growth findings.