EFFECTS OF THEOPHYLLINE ADMINISTRATION AND INTRACRANIAL ABNORMALITIES ON PROTECTIVE HEAD TURNING RESPONSE IN PRETERM INFANTS

ABSTRACTObjective: To determine effects of theophylline therapy for recurrent apnoea of prematurityand abnormal early (within the first 24 hours) cranial ultrasound abnormalities on protectiveneck turning response in preterm infants.Design: A cross sectional descriptive study.Setting: The Neonatal Unit of Hammersmith Hospital, London over a period of four months(February to May 1987) and the babies followed up for six months after discharge.Main Outcome Measures: Preterm babies of gestation 25 to 33 weeks confirmed by earlypostnatal Dubowitz assessment were studied. All infants had cranial ultrasound examinationwithin the first 24 hours of birth. Protective side turning response was recorded for each babyweekly until discharge. The pattern of maturation of the response was then analysed.Results: Thirty preterm infants (mean gestation 30 weeks) were studied. The babies treatedwith theophylline had significant (p=0.004) delay in the maturation of the response. Thisimproved within two weeks of stopping treatment. Eight infants had intracranial haemorrhageand seven had periventricular density. Both these groups were similar with respect to thematuration of the response. No significant interaction was found between theophyllinetherapy and abnormal cranial ultrasound as regards the protective side turning response. Sixmonths follow up showed no serious neurological abnormalities among the infants.Conclusion: Theophylline administration and perinatal brain injury may have a delayingeffect on protective head turning response in the neonatal period and therefore should betaken into account during neurological examination of the preterm neonate. This effect doesnot seem to result in any significant long-term neurological sequelae