NEUROLOGIC LESIONS IN THE NEWLY BORN INFANT
Authors: KEITH HADDOW M. , NORVAL MILDRED A. 
Published: December 2021

Among 4,464 births which took place during a period of four years, 1944 through 1947, there were 57 infants who had demonstrable neurologic lesions. Six of the 57 died with conclusive evidence of gross intracranial hemorrhage due to trauma. None of the six had been subjected to "difficulties of labor," five having had spontaneous births and one having been born by breech delivery which was not considered difficult.

Twenty-two other infants died within a few minutes after birth or after intervals of days or weeks. Twenty of these had gross lesions of such type that injury at birth or difficulties during delivery definitely could not be considered the cause of death. The other two probably had injuries due to difficulties of birth but one had hydrocephalus which may have been the cause and not the result of the injury.

Of the remaining 22 infants who survived for nine months or more, 13 had gross neurologic abnormalities. Two of the remaining nine were subjected to difficulty during birth. One had bilateral brachial palsy and one had two convulsive seizures. Both were quite normal at 1 year and at 15 months of age, respectively. Six of the nine had muscle twitchings or convulsions, but were well after intervals of seven months to 4½ years. These children must be observed for many years to determine what their future course may be. The remaining child had multiple congenital abnormalities and experienced convulsions.

Among the 57 infants, there were only five who had frankly difficult births. Two recovered completely. One died with a subdural hematoma, one with hydrocephalus and intraventricular hemorrhage, and one after attacks of cyanosis. Delivery in the last case was a "difficult breech," but necropsy showed evidence of anoxia with no hemorrhage.

It seems reasonable to conclude that difficulties during delivery had comparatively little to do with persistent neurologic abnormalities in most of the infants who survived.

A survey was made to determine the relationship of prolonged labor, asphyxia and delayed respiration to the occurrence of trauma and, thereby, neurologic lesions of the infant. As might be expected, prolonged labor appeared to increase the risk of intracranial injury and death of the infant. However, if the infants survived, there was little or no abnormality in subsequent development and no increase in neurologic disturbances, at least during the first few years of life. More children had convulsive disorder in the "normal" or control group than in the group of those subjected to prolonged delivery. The same held true among the infants who were asphyxiated, that is, there were more who had convulsive disorder in the control group than among those who were asphyxiated. There were more deaths and more abnormal infants among those who were asphyxiated, but these included a considerable number of premature infants, many of them being not viable. If the infants survived the neonatal period, they developed normally, or at least no more abnormalities were noted among those who were asphyxiated than among the controls.

Anoxia caused by delay in respiration did not have a serious prognosis in those infants who survived the neonatal period. Even a delay of 11 to 15 minutes, while fatal in 2 instances, did not appear to cause any abnormality, at least during the first four years of life, in the infants who survived.