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Benign transient downward gaze in preterm infants
M D Kleiman1, F J DiMario, D A Leconche
1Department of Pediatrics, University of Connecticut Health Center, Farmington 06030-6110.
Pediatric Neurology
|June 1, 1994
Summary
Extremely preterm infants may experience downward gaze episodes, often linked to stimulation or feeding. This transient condition typically resolves, indicating a possible delay in upward gaze reflex development.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Ophthalmology
Background:
- Preterm infants, particularly those extremely preterm (22-25 weeks gestation), can exhibit unusual neurological signs.
- Downward gaze episodes have been observed in some preterm infants, necessitating further investigation into their cause and prognosis.
Purpose of the Study:
- To evaluate episodes of conjugate downward gaze in preterm infants.
- To determine the clinical characteristics, neuroimaging findings, and developmental outcomes associated with this phenomenon.
Main Methods:
- Case series evaluating five preterm infants (3 extremely preterm, 2 twins at 28 weeks) with daily downward gaze episodes.
- Clinical observation, neuroimaging studies, and follow-up assessments up to 34 months corrected age.
- Correlation of gaze episodes with stimulation and feeding patterns.
Main Results:
- All infants experienced brief, daily downward gaze episodes, sometimes exacerbated by stimulation or occurring before feeding.
- No associated changes in vital signs, consciousness, muscle tone, or focal neurological deficits were noted.
- Neuroimaging was normal in 3/5 infants; follow-up showed resolution or decreased frequency of downward gaze, with normal development in 4/5.
Conclusions:
- Intermittent tonic downward gaze is a benign finding in extremely preterm infants.
- It may represent a maturational delay in upward gaze reflex systems.
- This condition typically resolves with age, and infants often achieve normal development.