Vestibulospinal Component of Postural Control (Vestibular Function) in Very Preterm Infants (25 to 27 Weeks) at 3,6,and 12 Months Corrected Age

Abstract

Postural control, which is important for the development of all movement, balance, and locomotion, depends a great deal on the vestibulospinal component of vestibular function in early childhood. Vestibulospinal input is important for muscle power regulation, which, in turn, influences postural control. The aim of this study was to focus particularly on this component of vestibular function during the first year of life in 67 infants with a very short gestational age (25-27 weeks), to search for possible neonatal confounders, and to see whether it influences the course of muscle power development in preterm infants. Outcome was described as being optimal, suspect, or abnormal. The infants were categorized into the Neonatal Medical Index according to the severity of neonatal illness and separately into three groups for neonatal brain ultrasonography findings (normal to severe abnormalities). At the age of 3 months, 20 infants performed optimally on all items testing vestibular function, increasing to 40 at 6 months and 48 at 12 months. This significant improvement (also seen in muscle power regulation) was primarily caused by better head control (during the traction response and prone position), whereas less shoulder retraction and hyperextension were found in the sitting position. Vestibular function was significantly related to brain ultrasonography classification but not to gestational age, birthweight, the Neonatal Medical Index, or gender. (J Child Neurol 2004;19:614-618).

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References

Westcott SL , Pax Lowes L. , Richardson PK : Evaluation of postural stability in children: Current theories and assessment tools. Phys Ther 1997;77:629-645.

Cohen H. , Keshner EA : Current concepts of the vestibular system reviewed: 2. Visual/vestibular interaction and spatial orientation. Am J Occup Ther 1989 ;43:331-338.

Keshner EA , Cohen H. : Current concepts of the vestibular system reviewed: 1. The role of the vestibulospinal system in postural control. Am J Occup Ther 1989;43:320-330.

Kaga K. , Maeda H. , Suzuki J. : Development of righting reflexes, gross motor functions and balance in infants with labyrinth hypo activity with or without mental retardation . Adv Otorhinolaryngol 1988;41:152-161.

Weismann BM , DiScenna AO , Leigh RJ : Maturation of the vestibuloocular reflex in normal infants during the first 2 months of life. Neurology 1989 ;39:534-538.

de Groot L. , van der Hoek A. , Hopkins B. , et al: Development of the relationship between active and passive muscle power in preterms after term age. Neuropediatrics 1992;23:298-305.

de Groot L. , Hopkins B. , Touwen BCL : Muscle power, sitting unsupported and trunk rotation in preterm infants . Early Hum Dev 1995;43:37-46.

de Groot L. : Posture and motility. Dev Med Child Neurol 2000;2: 65-68.

Samsom JF , de Groot L. , Hopkins B. : Muscle power and medical history in high-risk preterm infants at 3 months of corrected age. Neuropediatrics 1998 ;29:127-132.

10.

Samsom JF , de Groot L. , Hopkins B. : Muscle power in high-risk preterm infants at 12 and 24 weeks corrected age: A measure for early detection. Acta Paediatr 2001;90:1160-1166.

11.

Samsom JF , de Groot L. : The influence of postural control on motility and hand function in a group of high-risk preterm infants at 1 year of age. Early Hum Dev 2000;60:101-113.

12.

Dubowitz LMS , Dubowitz V. , Goldberg C. : Clinical assessment of gestational age in the newborn infant. J Pediatr 1970;77:1-10.

13.

Korner AF , Stevenson DK , Forest T. , et al: Preterm medical complications differentially affect neurobehavioral functions: Results from a new neonatal medical index. Infant Behav Dev 1994; 17:37-43.

14.

Papile LA , Burstein J. , Burstein R. , et al: Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birthweights less than 1500 g. J Pediatr 1978;92: 529-534.

15.

de Vries LS , Eken P. , Dubowitz LM : The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res 1992;49:1-6.

16.

Prechtl HFR : Assessment and significance of behavioral states, in Berenberg SR (ed): Brain, Fetal and Infant . The Hague, M. Nijhoff Medical Publishing, 1977, 79-90.

17.

Touwen BCL : Neurological Development in Infancy. Clinies in Developmental Medicine , no. 58. London, Heinemann, 1976.

18.

de Groot L. , Hopkins B. , Touwen BCL : A method to assess the development of muscle power in preterm infants after term age. Neuropediatrics 1992;23:172-179.

19.

Korner AF , Scheider P. , Forrest T. : Effects of vestibular-proprioceptive stimulation on the neurobehavioral development of preterm infants: A pilot study. Neuropediatrics 1983;14:170-175.

20.

White-Traut RC , Nelson MN , Silvestri JM , et al: Effect of auditory, tactile, visual, and vestibular intervention on length of stay, alertness, and feeding progression in preterm infants. Dev Med Child Neurol 2002 ;44:91-97.

21.

de Vries AM , de Groot L. : Transient dystonias revisited: A comparative study of preterm and term children at 2 1/2 years of age. Dev Med Child Neurol 2002;44:415-421.

22.

Samsom JF , de Groot L. , Bezemer PD , et al: Muscle power development during the first year of life predicts neuromotor behaviour at 7 years in preterm born high-risk infants. Early Hum Dev 2002;68:103-118.

23.

Torrioli MG , Frisone MF , Bonvini L. , et al: Perceptual-motor, visual and cognitive ability in very low birthweight preschool children without neonatal ultrasound abnormalities. Brain Dev 2000,22: 163-168.

24.

Birch EE , O'Connor AR : Preterm birth and visual development. Semin Neonatol 2001;6:487-497.

25.

Samsom JF , de Groot L. , Cranendonk A. : Neuromotor function and school performance in 7-year-old children born as high-risk preterm infants. J Child Neurol 2002;17:325-332.

26.

Pavlova M. , Staudt M. , Sokolov A. , et al: Perception and production of biological movement in patients with early periventricular brain lesions. Brain 2003;126:692-701.

27.

Staudt M. , Grodd W. , Gerloff C. , et al: Two types of ipsilateral reorganization in congenital hemiparesis: A TMS and fMRI study. Brain 2002;125:2222-2237.

28.

Eyre JA : Development and plasticity of the corticospinal system in man. Neural Plasticity 2003;10:93-106.

29.

Hopkins B. Development of action and the clinical continuum. Neural Plasticity 2003;10:15-25.

30.

Westrup B. , Stjernqvist K. , Kleberg A. , et al: Neonatal individualized care in practice: A Swedish experience . Semin Neonatol 2002; 7:447-457.

31.

Kleberg A. , Westrup B. , Stjernqvist K. , et al: Indications of improved cognitive development at one year among infants born very prematurely who received care based on the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Early Hum Dev 2002;68:83-91.

32.

Wolf MJ , Koldewijn K. , Beellen A. , et al: Neurobehavioral and developmental profile of very low birthweight preterm infants in early infancy. Acta Paediatr 2002;91:930-938.

33.

Jacobs SE , Sokol J. , Ohlsson A. : The Newborn Individualized Developmental Care and Assessment Program is not supported by meta-analysis of the data. J Pediatr 2002;140:699-706.

34.

Symington A. , Pinelli J. : Developmental care for promoting development and preventing morbidity in preterm infants. Cochrane Database Syst Rev 2001;CD001814.