Biomedical subjects
Publications and source records attributed to M Verghote.
The most common organisms in neonatal meningitis are group B streptococcus and Gram negative enteric bacteriae. Although Neisseria meningitidis, Haemophilus influenzae and Streptococcus pneumoniae are the most frequent causes of meningitis in infancy and childhood, they are uncommon in newborns. We report one case of neonatal meningitis and maternal septicemia.
A detailed neurological and neurobehavioural examination was done in 80 preterm infants of 27 to 35 weeks gestation in the first week of life and again at 40 weeks postmenstrual age, and in 40 appropriately-sized full-term infants on the first and fifth days of life. There were several consistent differences between the preterm infants reaching term and the newborn full-term infants. The preterm infants reaching 40 weeks showed less flexion in their posture, and less arm traction, arm recoil and leg recoil than the full-term infants on day 1, although this difference was less apparent by day 5. The preterm infants appeared not to develop the flexor tone of the full-term newborn. The preterm infants demonstrated better visual and auditory orientation and alertness than the full-term infants. The significance of these findings, both for initial neonatal examinations and for subsequent assessments, is evaluated.
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A method has been developed for the neurological assessment of the newborn infant comprising a carefully selected series of neurological and neurobehavioral items. It is applicable to preterm as well as full-term infants within 24 hours of birth, and can also be repeated sequentially on the same infant. The whole examination is recorded directly on a single sheet which also contains detailed instructions and diagrams. Individual items are scored on a 5-point scale, but no attempt has been made to compute a single total score, as it was thought more advantageous to document a pattern for individual groups of signs. Pilot studies have already demonstrated its sensitivity to perinatal factors such as drugs, asphyxia and infection. The examination can be rapidly documented by residents with no special training in newborn neurology. This method should provide a practical and objective means of monitoring the neurological status of the newborn infant, and also a baseline for longitudinal studies of neurological function in the newborn and developing infant.
Visual function in the preterm newborn infant has been studied by the visual orientation (tracking) technique of the Brazelton neurobehavioural assessment, and by the pattern preference and fixation techniques of Frantz. Both these methods demonstrated the presence of discriminative visual function by 31 to 32 weeks gestation, which by 34 weeks reaches a maturity comparable to the pattern found in fullterm infants. Sequential studies at weekly intervals of preterm infants, ranging in gestation from 28 to 32 weeks, have shown a similar pattern of development of visual function to that of the newborn infant of equivalent postconceptional age. However, comparative studies of visual orientation and pattern preference in the same infants have not shown a close correlation. The assessment of visual function in the preterm newborn infant is a valuable milestone. Aberrations may reflect a dificit in visual function itself, a more broad-based deficit in neurological function, or possibly a response to a generalised illness.
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