Biomedical subjects
Publications and source records attributed to H F Prechtl.
The Neu-Laxova syndrome was diagnosed in a fetus at 34 weeks' gestation on the basis of ultrasonographic qualitative analysis of fetal movement patterns and malformations. The first ultrasound study was performed at 34 weeks' gestation and a dead 960 g female fetus was delivered at 36 weeks' gestation.
We prospectively studied the vagal response to feeding tube insertion in eight healthy preterm infants, on three occasions in each infant during the first three weeks of life. Heart rate, oxygen saturation, respiration and cerebral blood flow velocities were assessed before, during and immediately after insertion of an orogastric feeding tube. The whole procedure was recorded on video. The duration and quality of tube insertion and the behaviour of the infant were evaluated from the recordings. Twenty-one measurements in eight infants were evaluated. The heart-rate decrease observed immediately after tube insertion correlated significantly with the duration of tube insertion, the quicker the manipulation, the greater the heart-rate decrease (P = 0.000). The maximal decrease of oxygen saturation after tube insertion correlated with the degree of heart rate deceleration (P = 0.009). Significant alterations of the flow velocities were observed only when the heart rate fell below 80 beats/min. We speculate that such episodes of bradycardia can be avoided by carefully inserting the feeding tube over a period of at least 15 s.
Fourteen infants of 2 months or 6 months of age were video-recorded during polysomnography. Four were normal infants, five had a history of ALTE (apparent life threatening event) and five had repeated and prolonged apnoea during sleep. Two ALTE infants have been recorded at 2 months as well as at 6 months of age. Movements during sleep could be classified into general movements, isolated movements of the upper extremity, startles, head rotations, and trunk rotations. In the ALTE cases at 2 months of age, the motility was quantitatively not different from the control infants but was markedly reduced at 6 months of age. (All cases had their event before 8 weeks of age.) In contrast to these findings, infants with repeated apnoea did not show a clear change in the quantity of their movements. With the exception of one ALTE case at 2 months, all observed cases of ALTE and apnoeic infants showed an abnormal quality of their spontaneous movements during sleep. As reported in a previous study, all these cases had also been found moving abnormally during wakefulness. It is suggested that the abnormal motility is a sequelae of the event (ALTE or repeated apnoeas) with as a consequence, an impairment of neural functions.
The aim of the study was to analyse, with a more detailed classification the occurrence of movements and postures of the fingers in normal and brain damaged pre-term infants. To this end the same videorecordings of normal subjects of the study described by Cioni and Prechtl and those with defined brain lesions from the investigation by Ferrari et al. have been reanalysed. In three general movements, selected randomly from each infant, we assessed the finger movement. There was no systematic trend with age and the repertoire of finger patterns per observation varied between different individuals. Only one or two finger(s) move (pattern B) and synchronized finger opening-closing (pattern D) and the complex and variable movement of three or more fingers (pattern E) are all more often or even only seen during arm movements. Fisting without arm movement (pattern A-) was only seen less frequently in the control cases, in the infants with flares and one-sided lesions. On the other hand, the two latter groups had more often pattern C+ (opening of all fingers with arm movement) while B+ (only one or two fingers move with arm movement) and E+ (three or more fingers move variably with arm movement) was less frequent in the severely damaged infants. Albeit significant differences, the plotted data immediately show the large overlap of the findings between the groups. There was no difference in the fisting between low-risk and neurologically abnormal pre-term infants. These findings corroborate the conclusions that abnormal movements and postures are not useful in the diagnosis of pre-term infants with confirmed brain lesions because of the wide overlap between the values for normal and brain damaged infants.
Recently a new movement disorder has been described which develops in some preterm infants with bronchopulmonary dysplasia. The present report provides a detailed description (including polyelectromyographical and serial cranial ultrasound findings) of this syndrome in a single infant. The authors suggest that the movement disorder be called infantile chorea, because the movement characteristics and EMG bursting pattern resemble those of adult chorea. It is hypothesized that 'infantile chorea', which is assumed to be caused by dysfunction of the striato-thalamic circuitry, emerges at the age of two to three months post-erm as thalamo-cortical connections are supposed to become functionally active.
The developmental course of spontaneous motility was investigated in a group of 26 fullterm infants, affected by mild to severe hypoxic-ischaemic encephalopathy. Serial 1-h videorecordings were carried out from birth to 15-22 weeks and a quality assessment of general movements (GMs) was made from a replay of the videos. Neurological follow-up of the infants were continued until at least 18 months of age; neonatal EEG and neuro-imaging techniques (US-scan, CT or MRI) were also carried out in all cases. The results indicate that perinatal asphyxia has important effects on the spontaneous motility of fullterm infants. Hypokinesis occurred very frequently during the first days of life, followed by a transient or prolonged (lasting longer than 15-22 weeks) abnormal quality of GMs. In the first 2 weeks the results of GM assessment did not correlate with the simultaneous findings of neurological examination, neuro-imaging and EEG, whereas they did when the results at 15-22 weeks were considered. The changes in spontaneous motility and especially GM developmental trajectories were good predictors of the neurological outcome. The predictive value of GM assessment was found to be similar to that of EEG and neuro-imaging, and better than neurological examination.
In a group a eight healthy full-term newborns 6-h polygraphic recordings, which included EMG recording of eight arm muscles, were made to investigate the effect of behavioural state on general movement (GM) organization. Simultaneous video recordings supplied information about the form of the GMs. Additionally the effect of non-nutritive sucking during State 4 was evaluated. Behavioural state had a distinct effect on the makeup of GMs. GMs during State 4 displayed best the fluency and elegance which are characteristic of normal GMs. State-1-GMs were rare, had a short duration and sometimes had an abrupt onset. During State 2 GMs had a fragmented appearance. EMG differences between GMs in State 2 and State 4 were demonstrated in burst duration (longer during State 2) and tonic background activity in the upper arm muscles (lower during State 2). Occasionally State-2-GMs had an abrupt onset. These abrupt GMs were less often preceded by rapid eye movements and heart rate changes than State-2-GMs with a gradual onset. GMs during State 5 were abrupt and vigorous and often had a high frequency tremor superimposed. The EMGs of State-5-GMs revealed a shorter interval between the EMG bursts and a higher EMG burst amplitude in the upper arm muscles than present during State-4-GMs. Non-nutritive sucking during State 4 induced a reduction of movement amplitude, a increase of EMG burst duration and an increase of tonic background activity in the biceps brachii and the extensor carpi muscles.
The effect of intra-uterine movement restriction on the development of motor functions was studied longitudinally by comparing infants born after uncomplicated breech position (n = 13) with control infants (vertex position, n = 5-10). Before birth, fetal leg posture was studied at regular intervals by means of real time ultrasound observations, and classified as complete (n = 1), inconsistent (n = 6), or incomplete (n = 6) breech position. Limited extension of the hips, preference posture and joint position in percentage of time (each until 12 weeks), withdrawal reflex and magnet response (until 26 weeks) and posture while sitting, standing and walking without support (up to 12-18 months) were assessed longitudinally. The results showed statistically significant, positive relationships between intra-uterine breech position and neonatal limited extension of the hip-joint, between limited extension of the hip-joint and the percentage of time that the hips are in flexion during the first 12 weeks, between this flexion of the hips (in percentage of time) and an abnormally 'flexed' walking pattern at 12-18 months, and finally, between a positive magnet response at 6 months and an abnormal walking pattern at 12-18 months. These findings suggest that intra-uterine movement restriction of the legs can cause long term alterations in the development of motor functions (leg posture, reflexes and posture while walking), possibly mediated by alterations in proprioceptive feedback mechanisms.
OBJECTIVE: To investigate the relation between hourly fetal urine production rate (HFUPR) and behavioural states 1F and 2F (corresponding to quiet and active sleep, respectively) in normal near term fetuses. DESIGN: An observational study. SETTING: A clinic for antenatal care at a university hospital. SUBJECTS: Nineteen healthy pregnant women examined at 37 to 40 weeks of gestation. MAIN OUTCOME MEASURES: Fetal behavioural states (1F and 2F) were assessed by means of fetal heart rate patterns (FHR A and FHR B). Using real time ultrasonography, HFUPR (ml/h) was estimated during behavioural states 1F and 2F. RESULTS: During behavioural state 1F, HFUPR was significantly higher than during state 2F (P < 0.01). HFUPR falls by 47% from 50.8 +/- 24.4 ml/h in state 1F to 25.7 +/- 15.0 ml/h in state 2F. CONCLUSIONS: During active sleep (state 2F) hourly fetal urine production rate is considerably reduced as compared to quiet sleep (state 1F).
The development of posture during the prenatal period was studied longitudinally in 12 matched pairs of low-risk and high-risk preterm infants. The gestational age of the infants in both groups ranged from 28 to 36 weeks. The two members of each pair had the same gestational age at birth and the video recordings were performed at the same postmenstrual age. They were filmed more than three times during the prenatal period, each video recording lasting 1 h. Time of occurrence and duration of each posture were analyzed from replay of the video recordings. No age-specific preference posture described in the literature was found from birth until the term age between two groups. There was no age-related tendency in duration and frequency of postures between two groups. There was a clear-cut dominant head position to the right side from 31 weeks onward. Asymmetrical tonic neck postures (ATN) were very inconsistently present before the term age. And there was no significant difference in the occurrence of ATN postures between two groups. We could not find any specific abnormal postures in the high-risk group. Our study suggested that posture in preterm infants is not a good indicator of brain damage in the prenatal period.
In 17 fetuses with intrauterine growth retardation (IUGR), we studied the quantity of general movements and fetal breathing movements both cross-sectionally and longitudinally. In IUGR fetuses, cross-sectional comparisons were made between the quantity of fetal movements and (1) the fetal clinical condition and (2) the quality of general movements. In addition, the quantity of fetal movements in IUGR was compared with that in uncomplicated pregnancies and in pregnancies complicated by premature rupture of the amniotic membranes. In IUGR, the quantity of general movements declined from 25 weeks gestation onwards, whereas the quantity of fetal breathing movements increased. Longitudinal assessment of these parameters was obtained in four cases and showed a decline of general movements. No relationship between prenatal longitudinal data and neonatal outcome could be observed. Relating the quantity of general movements and breathing movements to the fetal condition, growth retarded fetuses were divided into three groups according to fetal deterioration. 1. Normal amount of amniotic fluid and normal fetal heart rate patterns. 2. Reduced amount of amniotic fluid. 3. Abnormal fetal heart rate patterns. The quantity of general movements as well as that of breathing movements was low in group 3, compared to group 1. In group 2 only the quantity of breathing movements and not of general movements was low. A similar pattern was found in the relation with the quality of general movements observed during fetal deterioration. Cross-sectional analysis of median values (28-31 weeks gestation) did not reveal differences in the quantity of general movements when IUGR, normal pregnancies and premature rupture of the membranes (with or without oligohydramnios) were compared. The quantity of fetal breathing movements was significantly lower in pregnancies complicated by IUGR and by premature rupture of the membranes with oligohydramnios compared to those of normal pregnancies and premature rupture of the membranes without oligohydramnios. In uncomplicated IUGR, the quantity of general movements and breathing movements is in the same range as in normal uncomplicated pregnancies. Similar to the quality of general movements, the quantitative variables were related to the fetal condition. However, in contrast to the quality of general movements, the quantity of general movements and breathing movements showed a high inter- and intraindividual variation. Therefore, the results of this study discourage the use of quantitative aspects of general movements and breathing movements as reliable indicators of the neurological condition in the individual fetus.
The effect of severe intrauterine growth retardation on the quality of general movements was studied longitudinally in 17 human fetuses. During the prenatal and postnatal periods, fetal movements were recorded by means of weekly 1 h ultrasound and video registrations. Neurological examinations were performed at 1, 3, 6 and 12 months after birth. No clear effect of uncomplicated intrauterine growth retardation could be detected on the quality of general movements. General movements became slow and small in amplitude (4/5) in cases where there was a reduction in the amount of amniotic fluid. Parallel to the onset of abnormal fetal heart rate patterns, general movements became poor in repertoire (7/7), while they were hardly discernible after further deterioration of the fetal condition (5/7). With the exception of 3 infants with cerebral haemorrhages, the quality of general movements observed just before and after birth was identical (13/16). In these infants, the quality of general movements as well as the results of the standardized neurological examination tended to normalize at 3 months and 1 year, respectively. Uncomplicated IUGR had no marked effect on the quality of general movements or on the results of the neurological examination at the age of 1 year.
The effect of severe oligohydramnios (due to prolonged premature rupture of the membranes (PROM)) on breathing movements and lung development was studied longitudinally in 11 human fetuses. Prenatally, fetal breathing movements (FBM) were scored off-line from weekly, 1 h during ultrasound recordings (n = 47). In each recording, the incidence of FBM was scored according to 4 different methods. Postnatally, the cases were retrospectively assigned to a group with normal (n = 4), partially hypoplastic (n = 3), or hypoplastic (n = 4) lungs. Compared to control fetuses, the percentage of time spent breathing (%FBM) was low (2-5%) and did not increase with gestational age. Large inter-individual and intra-individual variations in the %FBM were found in all 3 diagnostic groups. Evaluation of the %FBM according to the 4 different methods revealed no significant differences between the 3 groups. We conclude that lung development is, at least partly, independent of the incidence of FBM. Furthermore, the analysis of FBM cannot reliably predict lung development in fetuses with oligohydramnios due to PROM.
The development of the motor component of the embryonic and fetal central nervous system can be studied by observation of fetal movements, using real-time ultrasound. In this paper data on emergence and development of fetal movement patterns and behavioural states are reviewed in the light of the normal development of the nervous system, identification of disturbances in normal development and testing behavioural teratogenicity in the human.
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Polygraphic recordings were obtained for 24 normal full-term neonates on their 4th or 5th day of life. Thirteen of the infants were first fed, laid supine for 3 hours, fed again around noon and laid prone for 3 more hours. The other 11 were first laid prone and then supine. The awake state was observed more in the supine than the prone position (P less than 0.001). Wakefulness occurred at the expense of state 1 and/or state 2. The heart rate (HR) was higher in babies lying prone. It was also higher in the afternoon than in the morning. No such relationship was found for the respiratory rate (RR). There was higher average EMG activity during state 1 in the prone position. The cross-correlation between HR and EMG activity was positive during state 2, and states 4 and 5, regardless of the position. The cross-correlation between the RR and the EMG was usually negative in state 2, and in states 4 and 5, there being many exceptions. The cross-correlation between breathing and heart-beat was mostly negative during state 2, but it eventually became positive due to periodic breathing, central apnoeas with bradycardia, stretches, and crawling movements.
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The development of spontaneous motility and posture was studied longitudinally in 14 carefully selected low-risk preterm infants. The aim of this investigation was to provide a set of data suitable for comparison with fetuses and with neurologically abnormal preterm infants. The infants were videorecorded weekly, for one hour in a supine position, from birth until their discharge from the hospital. Ten of them were thereafter also observed at home at 3-week intervals from 3 to 18 weeks of corrected age, together with 10 healthy fullterm infants. Occurrence and duration of motor patterns and postures in periods of rest and activity were obtained by off-line analysis of the videotapes. Few significant changes were found from birth until term age in the composition and quantity of the spontaneous movement patterns. Only twitches and stretches during activity periods showed a small decline approaching term age. However, notable inter-individual differences and intra-individual fluctuations from week to week were observed. Postterm development of preterm infants was similar to that of the fullterms. Both showed considerable changes in the qualities of general movements after the first postterm weeks. Only fidgety character movements occur earlier in preterm infants. No age-specific preference postures of the limbs were found in the preterm period. Midline position of the head in supine was observed at about the same postterm age in preterm and fullterm groups. Asymmetrical tonic neck postures were very inconsistently present before term age and rapidly disappeared after term, earlier so in preterm infants.