This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Modern methods of perinatal care have resulted in an increased survival of high risk infants. These infants have in the past contributed disproportionately to the neurologically impaired population. The purposes of this study are to (1) provide follow-up assessment of these infants (2) provide for early intervention if required and (3) assess the effects of new methods utilized in neonatal care settings. This study uses the developmental testing room in addition to the outpatient facilities of the GCRC. Infants are examined before discharge and then at 40 weeks, 4 months, and 8 months corrected age. At the 8 month visit a Bayley Developmental Assessment is performed. Thereafter, the infant is seen at 20 months corrected age for a physical, neurological, and a Bayley developmental assessment. The method of neurological examination utilized during infancy is that developed by Dr. Amiel Tison of Paris. It is employed sequentially during the infant's first year of life and permits the classification of infants into normal, suspect and abnormal groups. After the first year a standard pediatric neurologic examination is utilized. Infants defined as neurologically abnormal include those with hypotonia, cerebral palsy, hydrocephalus or convulsions. Cerebral palsy is defined as spastic diplegia or quadriplegia. With diplegia there is a symmetrical spastic diparesis, the legs more affected than the arms. With quadriplegia the arms are more affected than the legs. Outcome is measured by (1) the incidence of major central nervous system abnormalities including cerebral palsy, hydrocephalus, epilepsy and other related lesions, (2) the level of intellectual function as measured by Bayley tests. Social, antenatal and perinatal factors are documented and neonatal intensive care events are recorded during the hospital stay.
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