Abstract
This study examined the dependability of repeated systematic moment-to-moment observations of neurological signs in detecting early hypocalcemia of prematurity. Seventeen preterm appropriate-for-gestational age newborns (PT/AGA) 29-32 weeks gestational age (GA); birthweight (BW) 830-1490 grams; 1 minute Apgar 0 to 8; 5 minute Apgar 1 to 9; 13 F and 4 M) were observed live by two trained raters on three 20 minute occasions every day for the first 5 days. The behavioral coding system consisted of 11 general categories (each with specific behaviors) including: state control, vocal and visual behavior, fine motor coordination, limb, head and hand movement (smooth versus jerky; symmetric versus asymmetric). The system was reliable across raters but there were no dependable trends over time. Correlational analysis was done on frequency and duration scores averaged over raters and sessions. Across most behaviors, there were consistent and significant individual differences related to GA and 1 and 5 minute Apgar scores (Pearson r between .48 and .73, p<.05): Higher GA and .BW, and higher Apgar babies exhibited more alertness, more REM sleep, smoother and more coordinated movements of limbs and hands. Lower GA and BW, and lower Apgar babies had more jerky movements, were less coordinated and had poorer state control. Seven of 17 infants were hypocalcemic (Ca<6.5 mg/dl) during the first 36 hours of age; hypocalcemia and blood calcium did not relate to neurobehavioral signs (p>.10). In conclusion, neurobehavioral signs attributed to hypocalcemia are more likely due to gestational immaturity and lower Apgar scores rather than to hypocalcemia in the PT/AGA.
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Steichen Asch, P., Steichen, J. & Tsang, R. NEUROBEHAVIORAL MEASURES RELATE TO GESTATIONAL MATURITY AND NOT TO HYPOCALCEMIA OF PREMATURITY. Pediatr Res 21 (Suppl 4), 184 (1987). https://doi.org/10.1203/00006450-198704010-00110
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DOI: https://doi.org/10.1203/00006450-198704010-00110