Advances in neonatal neurology

The recent advances in neonatal neurology which are discussed include i) the improved organization of perinatal medical services, ii) technological advances including ultrasonography, brainstem auditory evoked responses and intracranial pressure monitoring and, iii) new developments in therapeutics. The development of departments of perinatal medicine has meant that neonatal pediatricians and obstetricians now enjoy close links which result in benefit to the fetus. The widespread use of fetal monitoring during difficult births is one result of this. Tertiary level neonatal units in major obstetric centers must be established by health care decision-makers under pressure from their colleagues in paediatric neurology. Ultrasound examination of the neonatal brain is convenient and almost as reliable as CT scanning. Its use in the diagnosis of hemorrhage, CNS malformations, monitoring of infective processes and of progressive hydrocephalus is now well established. Brainstem auditory evoked responses are of value in the early detection of hearing loss and in the assessment of brainstem maturity. They may be useful in the detection of impending damage in patients with hyperbilirubinemia and those under treatment with aminoglycoside antibiotics. Non-invasive intracranial pressure monitoring offers promise in managing post-hemorrhagic hydrocephalus and in prognostication in hypoxic-ischemic brain damage. Neonatal meningitis remains a serious threat. The newer antibiotics to date have not improved the prognosis. For neonatal convulsions, phenobarbitone remains the drug of first choice and is best given intravenously by loading dose.