ABSTRACT
Seventy infants born before 33-weeks gestation were studied by serial ultrasound brain
scans from the first days of life; twenty had periventricular hemorrhage (PVH). Weekly
neurologic examinations were performed from age 5 to 10 days. Only measures of passive
tone could be elicited before an age equivalent to 34-weeks gestation because the
infants were very sick, and many were receiving treatment with mechanical ventilation.
Gestation was the most important determinant of this aspect of neurologic functioning,
and no effect of time from birth was noted. Before ages equivalent to 34-weeks gestation,
no significant relationship was found between measures of passive tone, including
the size of the popliteal angle, and PVH diagnosed by ultrasound. At ages equivalent
to 34 weeks or more, measures of active as well as passive tone and reflexes were
consistently elicited. No single measure discriminated between infants with or without
PVH, but serial observations indicated that persisting imbalance of active tone and
clonus were only noted in infants with PVH, including 7 of the 8 infants who had PVH
complicated by ventricular enlargement.
It was concluded that neurologic examination does not reliably diagnose PVH during
the neonatal period in sick, very preterm infants. At an age equivalent to term, it
may help to distinguish infants who sustained permanent brain damage in association
with neonatal PVH which may lead to adverse sequelae at follow-up.
