VEPs in normal full-term and premature neonates: longitudinal versus cross-sectional data

VEPs have been shown to change with CNS maturation in children, yet few studies had documented maturational changes in the premature infant. Using LED goggles, VEPs were studied in 75 neurologically normal infants of 22-42 weeks gestational age (GA) within the first 3 days of life. Twenty of these (22-32 weeks GA) were also followed longitudinally. The 22-23 week GA neonates had no identifiable waves. In all infants greater than 24 weeks a large negative wave is seen with a latency around 300 msec (N300). After 27 weeks GA a late positive wave was present (P400), but with more variable latency and morphology. Between 30 and 35 weeks GA a small positive wave (P200) was seen in over one-third of the neonates; this component was present in all infants greater than 36 weeks GA. The consistency of the N300 across the ages studied suggests that it might arise from the basilar dendrites in the visual cortex, which are well developed by 24 weeks GA and undergo relatively little further development between 24 weeks and term. The P200 is suggested to arise from the apical dendrites which develop in the last trimester, explaining the emergence of P200 after 30 weeks GA. The infants followed longitudinally showed the same components, emerging in the same order, but with more rapid development (particularly of P200) compared to the cross-sectional studies. These data suggest that there are differences in the maturation of the visual system in the extrauterine versus intrauterine environment.