The specificity and sensitivity of positive rolandic sharp waves (PRSW) on serial EEGs for the diagnosis of periventricular leukomalacia (PVL) in premature infants was studied in 83 newborn cases (11% of 765 premature infants) treated at the Hopital Antoine Beclere, Assistance Publique/Hopitaux de Paris, Clamart, France. All prematures underwent repeated ultrasound scanning and EEGs during the first weeks of life. Those showing persistent hyperechoic periventricular densities on ultrasound had MRIs performed. Of the 83 with PVL, 65 had cystic PVL. PRSW were present in 55 cases, and EEG abnormalities preceded the ultrasonic detection of cystic PVL. PRSW were specific markers for both cystic and noncystic PVL, and PRSW sensitivity was dependent on gestation age, with higher frequency (88%) in infants of 28-32 weeks than in those born before 28 weeks (32%). [1]

COMMENT. Positive rolandic sharp waves on the EEG are specific for the development of periventricular leukomalacia and subsequent neurologic impairment in premature infants.

Outcome predictive value of neonatal assessment of preterm infants. Clinical assessment in the intensive-care unit was used to predict normal or abnormal motor outcome at 6 years, in a study of 153 infants followed in the Department of Perinatal Medicine, King George V Hospital, Sydney, Australia [2]. Neonates were classified according to the absence, transient occurrence, or persistence of atypical signs, including jitters, asymmetric tonic neck reflex, hypotonia, or hypertonia. Absence of atypical signs predicted normal development for 62% of 116, whereas one or more atypical features predicted major motor dysfunction in 7 of 11 infants.

Retinopathy of prematurity and autistic disorder. Blindness due to retinopathy of prematurity was strongly associated with autistic spectrum disorders in a controlled population-based study of 27 children at the University of Stockholm, Sweden [3]. The association was probably mediated by brain damage, independent of the blindness per se.