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Deep tendon reflexes in premature infants
K C Kuban1, H N Skouteli, D K Urion
1Department of Neurology, Children's Hospital, Boston, MA 02115.
Insights
Deep tendon reflexes (DTRs) in premature infants show that the pectoralis major reflex is most easily elicited. Reflex elicitation and intensity vary with gestational age, with less mature infants exhibiting diminished responses.
Area of Science:
- Neonatal Neurology
- Developmental Pediatrics
- Neuroscience
Background:
- Deep tendon reflexes (DTRs) are crucial indicators of neuromuscular development.
- Assessing DTRs in premature infants presents unique challenges due to developmental immaturity.
Purpose of the Study:
- To evaluate the elicitation rates and characteristics of ten classic DTRs in premature infants.
- To determine the influence of post-conceptional age and other factors on DTRs in this population.
Main Methods:
- Evaluated ten classic deep tendon reflexes (DTRs) in 62 premature infants (>27 weeks post-conceptional age).
- Compared reflex elicitation rates and intensity between infants <33 weeks and 33-36 weeks gestation.
- Observed effects of infant state, head position, and theophylline therapy.
Main Results:
- Pectoralis major reflex was 100% elicitable across all maturities.
- Achilles, patellar, biceps, thigh adductors, and brachioradialis reflexes were highly elicitable (>98%) in infants >33 weeks gestation.
- Less mature infants (<33 weeks) showed decreased elicitation for patellar and biceps reflexes and diminished overall reflex intensity.
- Finger flexors, jaw, crossed adductors, and triceps reflexes were less frequently elicited.
- Theophylline therapy tended to intensify the Achilles reflex; quiet, wakeful state was optimal for elicitation.
Conclusions:
- Gestational age significantly impacts the elicitation and intensity of specific DTRs in premature infants.
- The pectoralis major reflex is a reliable indicator in this population.
- Optimal state and potential therapeutic influences (e.g., theophylline) should be considered when assessing DTRs in neonates.
Abstract:
Ten classic deep tendon reflexes (DTRs) were evaluated in 62 premature infants of greater than 27 weeks post-conceptional age. The pectoralis major was the most readily elicitable reflex in all infants (100%), regardless of maturity. Achilles, patellar, biceps, thigh adductors, and brachioradialis reflexes also were obtained in at least 98% of babies of greater than 33 weeks gestation. Among these reflexes, less mature infants (less than 33 weeks gestation) had decreased elicitation rates for patellar and biceps reflexes and overall had diminished reflex intensity when compared to older infants (33-36 weeks gestation). By order of decreasing rate, finger flexors, jaw, crossed adductors, and triceps reflexes were less frequently elicited in both groups. Equal DTRs were obtained often in healthy and previously ill infants of less than 33 weeks gestation. Head position had no apparent affect on the ability to elicit reflexes. Theophylline therapy tended to intensify the Achilles reflex and the quiet, wakeful state appeared to be the most optimal state for the elicitation of DTRs.