Neurologic signs in neonatal intraventricular hemorrhage: a correlation with real-time ultrasound

A comprehensive neurologic assessment was applied sequentially in 100 consecutive unselected newborn infants in our neonatal unit in parallel with independent sequential real-time ultrasonic examination of the head. The results were analyzed in three separate gestational groups: Group I, 31 weeks and below (n = 29); Group II, 32 to 35 weeks (n = 39); Group III, 36 weeks and above (n = 25). In the remaining seven infants the ultrasonic examination was technically unsatisfactory. Deviant neurologic signs were correlated in each group with the presence of intraventricular hemorrhage recognized by ultrasound. Impaired visual tracking, an abnormal popliteal angle, and the later development of roving eye movements correlated strongly with the presence of IVH in Groups I and II. Decrease in tone and poor motility correlated with IVH in Group II infants only. In Group III the number of cases with IVH was small and none of the clinical signs reached statistical significance. The results suggest that our system of careful sequential neurologic examination in the newborn period is a sensitive means of detecting the development of intraventricular hemorrhage in the majority of immature infants, and of following its progress and resolution.