Abstract 1401
ELBWs (BW 501-1001g) without neurological disabilities may have a variety of sensory-motor, perceptual, learning and academic problems. An association has been shown between severity of neonatal ultrasound (U/S) detected brain lesions and these problems at 8 years of age. Objectives: To determine if subtle deficits associated with neonatal brain lesions were detectable in a cohort of children free of gross morbidity at 4 years of age. Methods: ELBWs admitted between 1989 and 1993 were studied at age 4; exclusion criteria were: 1) multiple congenital anomalies; 2) severe sensory (blindness, deafness), motor (cerebral palsy), or cognitive deficits; 4) no English. The children were grouped by severity of brain injury: Group A (n=22) normal head U/S findings; Group B (n = 23) grades 1-2 intraventricular hemorrhage (IVH); Group C (n = 19) grade 3 IVH and Group D (n = 18) periventricular leukomalacia or echoes (PVL/E). There were no significant group differences in mean birthweight, gestational age, number of days ventilated, proportion of small for gestational age infants, or the incidence of bronchopulmonary dysplasia. Gender distribution was significantly different among the four groups but no significant gender differences in test performance were found. Tests used were the Miller Assessment of Preschoolers (MAP), and the Beery Developmental Test of Visual Motor Integration (VMI), tests designed to identify children who exhibit moderate or subtle problems in one or more areas of development. Results: Although all children achieved scores within normal percentile ranges, children in group D performed poorly compared with those in Group A with respect to visual motor integration ability (p < 0.010), tasks involving visual perception and visual memory, (the MAP Nonverbal Tasks Index), (p < 0.05), and to a lesser degree in tasks involving visual spatial information and motor planning, (the MAP Complex Tasks Index), (p = 0.11). MAP percentile scores are also grouped into more clinically relevant "risk category" scores. Scores below the 5th percentile on the MAP indicate the highest risk for dysfunction. More children in Group D fell into this category than Group A children on the Nonverbal Index (p < 0.10), and the Complex Tasks Index (p < 0.02). Increasingly severity of neonatal IVH (Groups A,B,C) was also associated with an increasing frequency of difficulties in all areas measured. Conclusions: Children with PVL/E deemed to be neurologically intact had significant impairments on measures of visual perception, visual memory, motor planning and visual spatial manipulation, detected at 4 years of age.
