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Relationship of cranial ultrasonography, visual and auditory evoked responses with neurodevelopmental outcome
D W Beverley1, I S Smith, P Beesley
1Department of Paediatrics, General Infirmary at Leeds.
Insights
Flash visual evoked responses (VERs) and brainstem auditory evoked responses (BAERs) in preterm infants with intraventricular haemorrhage (IVH) did not predict neurodevelopmental outcomes. Early absent VERs in infants with severe IVH normalized over time.
Area of Science:
- Neonatal Neurology
- Neurodevelopmental Pediatrics
- Neurophysiology
Background:
- Preterm infants are at risk for brain injury, including intraventricular haemorrhage (IVH).
- Visual evoked responses (VERs) and brainstem auditory evoked responses (BAERs) are electrophysiological measures used to assess neurological function in neonates.
- The prognostic value of these evoked potentials following IVH in preterm infants requires further investigation.
Purpose of the Study:
- To evaluate the utility of flash visual evoked responses (VERs) and brainstem auditory evoked responses (BAERs) as prognostic indicators for neurodevelopmental outcomes in preterm infants.
- To assess the impact of intraventricular haemorrhage (IVH) on VER and BAER parameters in the neonatal period and their evolution over 18 months.
Main Methods:
- Sixty-two preterm infants underwent serial cranial ultrasonography, flash VERs, BAERs, and neurodevelopmental assessments up to 18 months corrected age.
- Infants were categorized based on the presence and grade of IVH.
- VER and BAER latencies and neurodevelopmental status were analyzed in relation to IVH severity and over time.
Main Results:
- Eighteen infants developed IVH; four of six with grade III or IV IVH had absent VERs at term, which normalized by six months.
- Infants with IVH showed significantly shorter mean VER latency at term and six months compared to those without IVH, but this difference resolved by 12-18 months.
- No significant differences in BAERs were found between infants with and without IVH, nor were VERs or BAERs correlated with neurodevelopmental delay.
Conclusions:
- Neither flash VERs nor BAERs are reliable predictors of long-term neurodevelopmental disability or outcome in preterm infants following IVH.
- Transient abnormalities in VERs associated with severe IVH can resolve over time, highlighting the importance of serial assessments.
- Further research is needed to identify robust biomarkers for predicting neurodevelopmental trajectories in preterm infants with brain injury.
Abstract:
Sixty-two preterm infants were followed up with flash visual evoked responses (VERs), brainstem auditory evoked responses (BAERs) and neurodevelopmental assessments for 18 months after term. Cranial ultrasonography showed that 18 infants developed intraventricular haemorrhage (IVH) during the newborn period and four of six infants with grade III or IV haemorrhage had absent VERs at term. The mean latency of the VER in the infants with IVH was significantly shorter than that of infants without IVH. There was no correlation between the degree of ventricular dilatation at term and the latency of the VER. Six months after term the four infants with previously absent VERs had normal responses, though there was still a significant difference between the latencies of infants with and without IVH. At 12 and 18 months of age these differences had disappeared. BAERs were not significantly different in the infants with and without IVH, and there was no difference in the VERs or BAERs of infants with neurodevelopmental delay and those developing normally. Neither flash VERs nor BAERs provide a good prognostic indicator of future neurodevelopmental disability or outcome.