There is a steady increase in the survival rate of infants born very prematurely and who are discharged home before achieving full term age. A number of neurological evaluations are available to help identify full term infants and young children who either already show signs of or are suspect of developing a motor dysfunction such as cerebral palsy. However a similar examination of premature infants which reliably predicts future motor dysfunction has not been available.

A recent study has been published by a team of Australian investigators that was designed to assess the usefulness of an observational neurological examination of premature infants in an intensive care neonatal nursery¹. Because of the frailness of the premature infant and the confined environment in which the infant lives, observations were standardized that were reliable and practical under these conditions. The infants were tested in the neonatal nursery and then examined at age six to evaluate the efficacy of the observations for predicting motor dysfunction. The observations of the premature infants which were used are: course jitters; an asymmetrical neck reflex; stereotypical repetitive movements; and hypertonia. These were done under "standardized" conditions. The six month evaluation was a generally accepted evaluation of motor function.

Of eleven (11) children who were diagnosed as having cerebral palsy by age six, nine (9) had been recognized in the neo-natal premature nursery as being suspect. Thus, the success of an early examination to predict cerebral palsy was very high (82%) utilizing this evaluation method.

Comment: The need is obvious to be able to predict as early as possible with a reasonably high degree of certainty the future onset of the symptoms of cerebral palsy. Tests are available that are generally useful for full term infants and during the first two years of life. However, testing of the very premature infant has been less than satisfactory. The evaluation method developed by these authors appears to be useful in meeting this need. Having this information will provide the basis for giving priority to this group of infants to have focused assessments during early development and to be identified early for intervention services.

1Lacey, J.L., Henderson-Smart, DJ, Assessment of Preterm Infants in the Intensive Care Unit to Predict Cerebral Palsv and Motor Outcome at Six Years. DMCN40:5: 310-318