[Diagnosis of cerebral function disorders and subsequent brain damage in newborn infants under intensive care]

Possibilities of recognizing cerebral function disturbances in newborns as early as the acute phase of the condition, and of prognosticating permanent brain damage are described. Clinical findings such as lethargy or spasms in the second and third weeks of life following hypoxia indicate severe function disturbances with poor prognosis. In contrast, the same symptoms in the first week after a hypoxia or following a cerebral hemorrhage are only of relatively slight prognostic significance. Metabolic parameters such as lactate, hypoxanthine, CK-BB, and ammoniemia are elevated in the first few hours and days after a perinatal hypoxia and correlate with the current disturbances in the central nervous system. However, they are not indicative of a possible occurrence of later brain damage. Cerebral sonography furnishes excellent information concerning gross structural changes and cerebral hemorrhages. The extent of the hemorrhages, classified in 4 stages, correlates well with the later development. Less severe functional disturbances can also be identified by electroencephalography together with observation of behavior (polygraphy). Here also, findings correlate well with the children's subsequent development. The combination of sonographic findings and neurophysiological diagnosis is at present the best source of information concerning the later occurrence of brain damage.