The importance of early hearing screening has long been recognized, as the prognosis for the hearing impaired child is improved when the diagnosis is made as early as possible, and the intervention ...is begun immediately. For clinical screening of hearing impairment, the recording of otoacoustic emissions was recomended. As some risk factors for early brain damage are at the same time also risk factors for dysfunction of auditory system, we presumed that infants at risk for brain damage have hearing impairment more frequently than the rest of the population of the same age. We were interested in the role of otoacoustic emission testing during the assessment of auditory function in these infants. There were 110 infants at risk for brain damage included in the study. After thorough otorhinolaryngological examination, auditory function was estimated by recording of otoacoustic emissions, tympanometry, pure tone audiometry and, when necessary, auditory brainstem responses. Otoacoustic emissions were recorded by Madsen-Electronics Celesta 503 in an acoustically treated sound room. We registered spontaneous as well as transient and distortion product otoacoustic emissions. The neurologist formed two groups with different degrees of neurological risk. The collected results of auditory function were compared with the degree of neurological risk. For the statistical analysis, the procedure
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2 and Fischer test were used. Spontaneous otoacoustic emission was detected in 38.2% of examinees. Evoked otoacoustic emissions were registered in 87.3% of infants. The testing had to be repeated in 32.7% of infants. We observed evoked otoacoustic emissions to be present also in a child with sensorineural hearing impairment and no auditory brainstem responses. Up to 32.7% of infants at risk for brain damage were hard of hearing. Conductive hearing loss was discovered with 25.4% of infants, and eight (7.3%) had sensorineural hearing impairment. In the group of examinees with only risk factors 3.6% had sensorineural impairment and in a group with abnormal motor development, there were 18.5% with that kind of hearing loss. Fischer test confirmed a statistically significant difference between the groups. Infants at risk for brain damage have more frequently impaired auditory function than their peers. For this reason, it is especially important to focus attention on the hearing condition when dealing with this population. Recording of evoked otoacoustic emissions is very helpful in pediatric audiometry, but any interpretation of the results should consider the possibility of auditory neuropathy.
Having in mind a broad spectrum of differences in age of people at which firm diagnosis is made, inclusions and exclusions criteria, denominator for clinical features (topographical or other ...classification), and especially what was a cause and timing of insult, size and location of lesion, maturational state of system injured, integrity of areas surrounding and contralateral to lesion, genetic and environmental background, genegene and gene-environment interactions, and intervening conditions (timing of start, quality, duration and intensity), and that we do not know what are the potentials of the developing brain of the individual child to adapt to and to compensate for the damage, it is obvious that there are currently no evidence-based strategies for preventing CP and to say which method of treatment is superior. ...Advances in medical and surgical management are accelerating at a rapid pace.
Cerebral palsy is the most frequent motor impairment in childhood. In many countries, its prevalence is predicted to increase. There are an estimated 15 million people with cerebral palsy around the ...world and more than half of them are mentally retarded and one third have epilepsy. It should be seen that it is more than merely a motor disorder. There can be problems of development, perceptual-cognitive impairment, social and functional problems of daily living, emotional and behavioural problems, and many other difficulties. In addition to this early brain damage is not a synonym for Cerebral palsy. PUBLICATION ABSTRACT
Changes in the prevalence of cerebral palsy (CP) in a population of Slovenian children born between 1981 and 1990 were determined. A population‐based birth‐cohort study was undertaken. Seven hundred ...and sixty‐eight children with CP (aged 5 to 14 years) were identified from the National Cerebral Palsy Register in 1995. Spastic syndromes accounted for 84.8%. Of the 768 children studied, the total prevalence of CP per 1000 live births fell significantly from 3.3 in 1981 to 2.3 in 1990. This decreasing trend was observed in children born at <38 weeks of gestation and in those with a birthweight of <1500 g, but the prevalence of CP remained fairly constant in those born at ≥38 weeks of gestation and in those with a birthweight of ≥2500g. The results show that a statistically significant improvement in the survival rate of infants born in Slovenia between 1981 and 1990 was not accompanied by an increase in the prevalence of CP. Additionally, in the group of very‐low‐birthweight infants the prevalence of CP considerably decreased.
To verify the clinical usefulness of the optimality concept in general and its prognostic value for later outcome, all babies born at all 14 maternity hospitals in Slovenia in the period from 1987 to ...1991 (124,759 newborns) have been screened. In order to get an estimate of their condition Prechtl's original list of optimality has been adapted to 51 items representing mostly obstetric variables. The median of perinatal optimality scores for all newborns was 45 (six negative points) in mature, and 41 (10 negative points) in premature infants. Girls born at term scored better than mature boys, whereas there was no sex difference in the median score in prematures. Analysis of the data has shown that the majority of items which were non-optimal and which were associated with the greatest number of other non-optimal factors had to do with disturbances in oxygen supply. Children who developed cerebral palsy had a lower optimality score at birth than the remainder of the newborns. In these children the difference between the sexes is even more pronounced, to the advantage of the girls. Prematurely born children with spastic diplegia had a lower optimality score than mature children with diplegia. The opposite was noticed in children born prematurely and at term who developed spastic tetraparesis or dyskinesia. The present follow-up study has shown that predictions of disability were most accurate in the group of newborns who were clinically at risk at birth and who also had a low optimality score. The combination of both appraisals is the best way to identify newborns who need special attention.
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