QUALITATIVE ASSESSMENT OF GENERAL MOVEMENTS IN HIGH-RISK PRETERM INFANTS WITH CHRONIC LUNG-DISEASE REQUIRING DEXAMETHASONE THERAPY

Objective: The objective of this study was to determine in preterm inf ants al risk for severe chronic lung disease (1) the quality of genera l movements (GMs) and (2) the effect of dexamethasone treatment on spo ntaneous motor activity.Study design: In 15 very low birth weight infa nts the quality of GMs was assessed Gum repeated videotape recordings. Recordings were made at weekly intervals during the preterm period un til term age and thereafter three times until the twentieth postterm w eek. All infants required devamethasone therapy and additional recordi ngs were made a few hours before and 24 hours, 48 hours, and 7 days af ter dexamethasone was started. The relationship among movement quality , brain ultrasonographic abnormalities, and long-term outcome was expl ored. Acute effects of dexamethasone on motor activity were examined. Results: After dexamethasone therapy nas started, a significant transi ent reduction of the quantity of most spontaneous movements (p < 0,05) and a reduction of speed and amplitude of GMs was found (p < 0.05). A significant relationship was found between the severity of brain ultr asonographic abnormalities and the extent to which developmental traje ctories of GMs were abnormal (p < 0.001). The development of cerebral palsy was related to the presence of cramped-synchronized movements ne ar term (p < 0.02) and to the absence of fidgety movements at the age of 3 months after term (p < 0.05), Conclusion: In preterm infants with severe chronic lung disease and brain lesions, dexamethasone treatmen t leads to an acute reduction in motility and changes in the speed and amplitude of GMs. Until more is known, about long-term neurologic seq uelae, a cautious use of systemic dexamethasone therapy in preterm inf ants is recommended.