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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.
Insights
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.
Abstract:
Five preterm infants who had episodes of conjugate downward gaze 2-3 months after birth were evaluated. Three were extremely preterm, born at 22-25 weeks gestation, and 2 were twins, born at 28 weeks gestation. In all patients, multiple, brief episodes of downward gaze occurred daily, with each lasting for several seconds. In 3 infants, downward gaze occurred more often with stimulation, while in another it occurred more frequently prior to feeding. There was never an associated change in vital signs, level of consciousness, muscle tone, or focal neurologic deficit. All infants had bronchopulmonary dysplasia. Neuroimaging studies were normal in 3 patients and demonstrated nonspecific abnormalities in 2. At follow-up (6 1/2-34 months corrected age), intermittent downward gaze had completely resolved in 3 infants and was decreased in frequency and severity in the youngest 2. Four infants had normal development and neurologic examinations, while 1 child demonstrated mildly increased asymmetric muscle tone with normal development. Intermittent tonic downward gaze can be seen in extremely preterm infants who subsequently have normal development, and may represent a maturational delay in upward gaze reflex systems.