Early neurological signs in preterm infants with unilateral intraparenchymal echodensity

The aim of the study was to document the early developmental course of neur ological signs in a group of preterm infants at risk for hemiplegia due to unilateral intraparenchymal echodensity (UIPE). Sixteen preterm infants wit h UIPE and sixteen controls were given serial neurological examinations, ac cording to the protocols currently adopted in the different NICUs of the pr oject. Moreover, the quality assessment of their general movements (GMs) wa s assessed subsequently from videotapes, from birth until around four month s postterm. At two years, 12 of the UIPE infants showed hemiplegia and one suffered from asymmetrical diplegia. The findings of the traditional neurol ogical examination were abnormal for the large majority of the UIPE infants , although normal findings were also recorded in some cases, especially dur ing the preterm period. Asymmetries were found after term age in nine UIPE and in two control infants. From the first observation onwards, all infants with UIPE showed bilaterally abnormal GMs and in those with unfavourable o utcome fidgety movements (FMs) were absent. At the FMs period (9-16 weeks p ostterm), all infants with subsequent hemiplegia showed asymmetry of distal segmental movements which were reduced or absent on the side contralateral to the lesion. Conclusions: Unilateral brain lesions induce clear neurological signs and a bnormal GMs in particular, although these abnormalities are not initially a symmetrical. A reduction of segmental movements on one side of the body dur ing the third month postterm is highly predictive of hemiplegia.