Early Human Development. 30 (1992) 221-228
221
Elsevier Scientific Publishers Ireland Ltd. EHD 01333
Normal auditory brain stem evoked responses in infants of diabetic mothers Ingrid Grimmera, Regina M. Trammera, Karin K6stera, Franz Kainerb and Michael Obladen” pDepartment of Neonatology. Universitiits-Klinikum Rudolf Virchow, Free University of Berlin and bDepartment of Obstetrics and Gynaecology, Universitiits-Klinikum Rudolf Virchow. Free University of Berlin. (Germany)
(Received 23 February 1992; revision received 2 July 1992; accepted 13 July 1992)
Smunary Auditory brain stem responses potentials were recorded from 7 1 newborns within the first 2 weeks after birth; conceptional age ranged from 37 to 41 weeks. Thirtynine newborns were infants of diabetic mothers (IDMs) (17 White A, 22 White B-D) and 32 healthy term newborns served as control group. IDMs with additional high risk for cochlear or brain stem integrity were excluded. Birthweight for gestational age was significantly higher for IDMs. No differences in auditory brain stem responses wave latencies or amplitudes were observed between healthy infants of the control group and IDMs. Key words: auditory brain stem responses; brain maturation; mothers (IDMs)
infants of diabetic
Introduction Auditory brain stem evoked responses (ABRs) are an objective non-invasive measurement of maturation and functional integrity of the auditory pathway along the VIIIth nerve and the brain stem. ABRs have been reported to be useful in estimating the audiometric [2,5,17,28] and neurologic prognosis of high-risk neonates [6,13,14,27,29]. Pathologic changes of auditory brain stem responses have been reported in neonates after- perinaml hypoxia [ 1,5,17], hyperbihrubinaemia Correspondence to; Ingrid Grimmer, UKRV-C, Heubnerweg 6, 1000 Berlin 19, Germany.
Kinderklinik
Kaiserin,
0378-3782/92/$05.00 0 1992 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
Auguste Victoria
Haus,
222
[16,21,30], prenatal drug exposure [10,20] and in children with Down-syndrome r111. _ _ ABR parameters depend on gestational age and on myelination. Both absolute and interpeak latencies decrease with increasing postnatal age, but contrary results have been published on maturation of ABRs as a function of birthweight [25]. Weight-related investigations [3,8,22,23] have mainly been performed in small-for gestational age newborns. Up to now, no investigations of ABRs were published concerning infants of diabetic mothers (IDMs). As histopathologic findings [9] point to a delayed myelination in infants born to diabetic mothers, we put forward the hypothesis for the present investigation that intrauterine environmental factors in IDMs may influence myelination in the central nervous system and thereby affect impulse transmission. Patients and Methods This investigation has been part of a larger project evaluating the neurological integrity of high-risk neonates. The study protocol was approved by the Ethical Committee of the Free University Berlin; parental informed consent was obtained for each neonate included in the study. IDMs with known risk factors for cochlear or brain stem damage (n = 19) like peri- or postnatal hypoxia (e.g. meconium aspiration, umbilical artery pH < 7.2, hypothermia < 36.O”C), mechanical ventilation, intracranial haemorrhage, haemolytic disease and hyperbilirubinaemia requiring exchange transfusions or a family history of hearing loss were excluded (n = 19), but not infants suffering from hypoglycemia. Thirty-nine IDMs were examined prospectively. According to White’s classification (Table I), the mothers of 17 infants belonged to group A, 10 to group B, 8 to group C and 4 to group D. Thirty-two healthy fullterm infants born during the same period of time after unremarkable pregnancy, labour and delivery served as control group. According to the study protocol, normal cranial ultrasound scans were obtained before performing ABR measurements.
TABLE I Classification of the severity of diabetes mellitus (DM) according to White (see Ref. 7). Class
Definition
A B C D
Treated by diet only Onset of DM when aged 20 or older, duration < 10 years Onset at lo-19 years of age or duration lo-19 years Onset before 10 years of age or duration >20 years or with background retinopathy or hypertension Proliferative retinopathy or vitreous haemorrhage Nephropathy; more than 500 mg/day proteinuria Both criteria fullfilled Arteriosclerotic heart disease Renal transplant
R F R/F H T
223
We collected the following data in all newborns: umbilical artery pH, birthweight, length, head circumference, Apgar-score, and neurological status according to Schlack [26]. Total bilirubin levels were measured as clinically indicated, this was the case in 36 children. In addition, the average maternal insulin requirement (White group B-D) during the last week of pregnancy was calculated and the maximum amniotic fluid insulin concentrations were measured (RIA, Pharmacia Diagnostics AB, Uppsala, Sweden) when clinically indicated. Gestational age of the infants was calculated from the first day of the mother’s last menstrual cycle and from ultrasonographic assessment of the biparietal diameter during the first trimester. In one case, these data were not available and gestational age was determined postnatally using somatic criteria according to Finnstrom [4]. Because of the wide range of the gestational age between 257 and 294 days, we transformed the birthweight into relative values (birthweight ratio), i.e. the birthweight divided by the gestational age specific 50th percentile according to Keen and Pearse [12]. The conceptional age was defined as the sum of gestational age plus age after birth. It ranged from 37 to 41 weeks. The auditory brain stem evoked responses were measured after stabilising blood sugar levels, since during or shortly after periods of hypoglycaemia, changes in ABR were described in infants and children by Koh et al. [15]. ABRs were recorded after feeding and during spontaneous sleep within the first two weeks of life using a portable Nicolet Compact Four (CA 2000, Nicolet Biomedical Instruments Inc., Madison, WI, USA). ABR testing was performed using rarefaction clicks (100 psec) at a rate of 11.4/set delivered through ear tips connected to a tubal insert phone set (TIP-300/C-300, Nicolet Biomedical Instruments, Madison, WI). One-channel bioelectric activity was recorded using gold cup electrodes attached to vertex (Cz) and earlobes (Al/A2) with the forehead serving as ground (Fpz). Interelectrode impedance was 30 dB, n
f 0.25 f 0.27 f 0.31 ?? 0.09 f 0.05 0
2.83 7.91 5.08 0.29 0.19
f 0.31 zk 0.32 f 0.27 zt 0.08 ?? 0.05 0
2.73 7.88 5.15 0.27 0.20
1
2.77 7.89 5.12 0.24 0.21
0.26 0.32 0.27 0.10 ?? 0.07
zt f f zt
3
2.72 7.90 5.18 0.25 0.20
Left
Right
Right
Left
White B-D (n = 22)
White A (n = 17)
f 0.16 zt 0.32 f 0.37 & 0.05 + 0.06
Infants of diabetic mothers
There are no significant differences between the groups using analysis of variance with conceptional age as co-variable. ‘Measurements at 70 dB.
1
2.85 7.92 5.12 0.25 0.22
0.23 0.30 0.33 0.06 ?? 0.05
2.87 7.96 5.07 0.24 0.22
Wave I latency (ms)a Wave V latency (ms)a I-V interval (ms)a Amplitude wave I (pV)” Amplitude wave V (pV)”
f + f zt
Left
Control infants (n = 32) Right
Measurement
Auditory brain stem response measurements (mean * S.D.).
TABLE III
f 0.19 f 0.34 f 0.08 f 0.05
?? 0.33
226
ratios were significantly higher in IDMs. The mean values for head circumference were significantly higher only in White A IDMs than in control infants, including gestational age as co-variable in the analysis of variance. On the contrary, the birthlength related to gestational age did not show any significant differences between the three groups. Peak serum total bilirubin levels were < 340 pmol/l in all infants, exceeding 255 kmol/l only in four infants in the subgroup White A and in three infants in the subgroup White B-D. ABR parameters depend essentially on the maturity, but may also depend on elevated serum bilirubin level [ 161. Therefore, we calculated the regression between interpeak latency wave I-V and peak serum bilirubin level with conceptional age as the second variable (multiple regression analysis). No significant relation could be proved between this ABR parameter and the serum total bilirubin level. Amniotic fluid insulin concentrations were available for 23 IDMs. The maxima ranged between 2.3 and 17.1 pU/l. There was no significant correlation between these values and the measured ABR parameters (bivariate linear regression, covariable gestational age). ABR results are listed in Table III. The three groups did not differ with respect to ABR measurements. The absolute latency values for waves I and V in the control group are somewhat longer than commonly found [ 181. This fact is presumably due to marking technique. Discussion
It is not yet clear to what extent maternal metabolism during pregnancy affects further development and mental abilities of the IDMs. Rizzo et al. [24] found a correlation between maternal metabolism and later intelligence. However, significant bias must be considered as for example perinatal asphyxia. Mimouni et al. [ 191have observed perinatal asphyxia in 27% of the infants born to mothers suffering from diabetes B through R. In the present study, however, IDMs with perinatal asphyxia, intracranial haemorrhage and other risk factors for auditory impairment were excluded. Nevertheless, the increased birthweight ratio typical for IDMs was found in subgroup White A as well as in subgroup White B-D. It was not accompanied by changes of the latencies or amplitudes of the ABR. The ABR parameter did not differ between IDMs and control infants. We speculate that in our population, myelination of the auditory tract had not been affected by maternal diabetes or that there were only minor alterations which could not be detected by ABR parameters. Our results may be explained by improved glucose monitoring and optimal metabolic control of diabetic mothers. The fact that newborns do not show measurable differences in ABR conventional parameters, does not exclude the possibility that such differences may appear later in life. Our results are in agreement with Petersen [23] who recorded visual evoked potentials (VEP) in 20 fullterm IDMs and did not find any differences in VEP latency and VEP amplitude between healthy fullterm infants and IDMs. Further investigations have to be performed in order to find possible relations between maternal diabetes, the degree of fetal macrosomia, hypoxia and glucose homeostasis and later development of the central nervous system.
221
Acknowledgements This work was supported by Deutsche Forschungsgemeinschaft SFB 174/A9. We are grateful to Boris Metze for assisting us in realizing the statistical calculations. References 1 2 3 4 5 6 7 8 9
10 11 12 13
14 15 16 17 18 19 20 21 22
23
Barden, T.P. and Pelzmann, P. (1980): Newborn brain-stem auditory evoked responses and perinatal clinical events. Am. J. Obstet. Gynecol., 136, 912-919. Despland, P.A. and Galambos, R. (1980): The auditory brain stem response (ABR) is a useful diagnostic tool in the intensive care nursery. Pediatr. Res., 14, 154-158. Fawer, C.L. and Dubowitz, L.M.S. (1982): Auditory brainstem responses in neurologically normal preterm and fullterm infants. Neuropediatrics, 13, 200-206. Finnstrom, 0. (1972): Studies on maturity in new-born infants. II. External characteristics. Acta Paediatr. &and., 61, 24-32. Galambos, R. and Hecox, K.E. (1978): Clinical applications of the auditory brain stem response. Otolaryng. Chn. N. Am., 11,709-722. Hakamada, S., Watanabe, K., Hara, K. and Migazaki, S. (1981): The evolution of visual and auditory evoked potentials in infants with perinatal disorder. Brain Dev., 3, 339-344. Hare, J.W. and White, P. (1980): Gestational diabetes and the White classification. Diabetes Care, 3, 394. Henderson-Smart, D.J., Pettigrew, A.G., Campell, D.J. (1983): Clinical apnea and brain-stem neural function in preterm infants. New Engl. J. Med., 308, 353-357. Homm, C. (1990): Gliazelldifferenzierung und Myehnisierung im fetalen Rlckenmark. Immunbiologische Untersuchungen bei akuter und chronischer Plazentainsufftzienz. Inaugural-Disseratation, Berlin. Joint Committee on Infant Hearing 1990 (1991): Position statement. AAP News, 4, 6-14. Kaga, K. and Marsh, R.R. (1986): Auditory brain stem responses in young children with Downsyndrome. Int. J. Pediatr. Otorhi., 11, 29-38. Keen, D.V. and Pearse, R.G. (1988): Weight, length and head circumference curves for boys and girls of between 20 and 42 weeks’ gestation. Arch. Dis. Child., 63, 1170-l 172. Ken-Dror, A., Pratt, H., Zeltzer, M., Sujor, P. Katzir, J. and Benderley, A. (1987): Auditory brain stem evoked potentials to clicks at different presentation rates: estimating maturation of preterm and fullterm neonates. Electroencephalogr. Clin. Neurophysiol., 68, 209-218. Kileny, P. and Robertson, C.M.T. (1985): Neurological aspects of infant hearing assessment. J. Otolaryngol., 14, 34-39. Koh, T.H.H.G., Aynsley-Green, A., Tarbit, M. and Eyre, U.A. (1988): Neural dysfunction during hypoglycaemia. Arch. Dis. Child., 63, 1353-1358. Lenhardt, M.L., McArthur, R. and Bryant, B. (1984): Effects of neonatal hyperbihrubinemia on the brain-stem electric response. J. Pediatr., 104, 281-284. Marshal, R.E., Reichert, T.J., Kerley, S.M. and Davis, H. (1980): Auditory function in newborn intensive care unit patients revealed by auditory brain stem potentials. J. Pediatr., 96, 731-735. Maurer, K., Leitner, H. and Schafer, E. (1982): Akustisch evozierte Potentiale (AEP). Ferdinand Enke Verlag, Stuttgart 1982, 99 pp. Mimouni, F., Miodomic, M., Siddiqi, T., Khury, J. and Tsang, R.C. (1988): Perinatal asphyxia in infants of insulin-dependent diabetic mothers. J. Pediatr., 113, 345-353. Oro, AS., Dixon, S.D. (1987): Perinatal cocaine and methamphetamine exposure: Maternal and neonatal correlates. J. Pediatr., 111, 571-578. Perlman, M., Feinmesser, P., Sohmer, H., Tamari, H., Wax, Y., Persmer, B. (1983): Auditory nervebrain-stem evoked responses in hyperbilirubinemic neonates. Pediatrics, 72, 658-664. Pettigrew, A.G., Edwards, D.A. and Henderson-Smart, D.J. (1985): The influence of intra-uterine growth retardation on brain stem development of preterm infants. Dev. Med. Child Neurol., 27, 467-472. Petersen St., Ryds, 0. and Trojaborg, W. (1990): Visual evoked potentials in term light-forgestational-age infants of diabetic mothers. Early Hum. Dev., 23, 85-91.
228
24
25
26 27 28 29 30
Rizzo, B., Arduini, P., Luciano, R., Rizzo, C., Tortorolo, G., Romanini, C. and Mancus, S. (1989): Prenatal cerebral Doppler ultrasonography and neonatal neurologic outcome. J. Ultrasound Med., 8, 237. Samani, F., Pechiulli, G., Pastorini, S. and Fior, R. (1990): An evaluation of hearing maturation by means of auditory brain stem response in very low birthweight and preterm newborns. Int. J. Pediatr. Otorh., 19, 121-127. Schlack, H.G. (1979): Erfassung zerebraler Bewegungsstorungen im ersten Lebensmonat. Dtsch. Med. Wochenschr., 95, 1554-1561. Smyth, V., Scott, J. and Tudehope, D. (1990): The utility of the auditory brain stem response as a screening procedure. Int. J. Pediatr. Otorh., 19, 45-55. Stein, L., &damar, t)., Kraus, N. and Paton, J. (1983): Follow-up of infants screened by auditory brain stem response in the neonatal intensive care unit. J. Pediatr. 103, 447-453. Steven, A.J. (1984): Hearing screening of high-risk newborns with brain stem auditory evoked responses. Int. Med. Care J. (Hospimedica), 9-10, 83-88. de Vries, LX, Lary, S., Dubowitz, L.M.S. (1985): Relationship of serum bilirubin levels to ototoxicity and deafness in high-risk low-birth-weight infants. Pediatrics, 76, 351-354.
221
Elsevier Scientific Publishers Ireland Ltd. EHD 01333
Normal auditory brain stem evoked responses in infants of diabetic mothers Ingrid Grimmera, Regina M. Trammera, Karin K6stera, Franz Kainerb and Michael Obladen” pDepartment of Neonatology. Universitiits-Klinikum Rudolf Virchow, Free University of Berlin and bDepartment of Obstetrics and Gynaecology, Universitiits-Klinikum Rudolf Virchow. Free University of Berlin. (Germany)
(Received 23 February 1992; revision received 2 July 1992; accepted 13 July 1992)
Smunary Auditory brain stem responses potentials were recorded from 7 1 newborns within the first 2 weeks after birth; conceptional age ranged from 37 to 41 weeks. Thirtynine newborns were infants of diabetic mothers (IDMs) (17 White A, 22 White B-D) and 32 healthy term newborns served as control group. IDMs with additional high risk for cochlear or brain stem integrity were excluded. Birthweight for gestational age was significantly higher for IDMs. No differences in auditory brain stem responses wave latencies or amplitudes were observed between healthy infants of the control group and IDMs. Key words: auditory brain stem responses; brain maturation; mothers (IDMs)
infants of diabetic
Introduction Auditory brain stem evoked responses (ABRs) are an objective non-invasive measurement of maturation and functional integrity of the auditory pathway along the VIIIth nerve and the brain stem. ABRs have been reported to be useful in estimating the audiometric [2,5,17,28] and neurologic prognosis of high-risk neonates [6,13,14,27,29]. Pathologic changes of auditory brain stem responses have been reported in neonates after- perinaml hypoxia [ 1,5,17], hyperbihrubinaemia Correspondence to; Ingrid Grimmer, UKRV-C, Heubnerweg 6, 1000 Berlin 19, Germany.
Kinderklinik
Kaiserin,
0378-3782/92/$05.00 0 1992 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
Auguste Victoria
Haus,
222
[16,21,30], prenatal drug exposure [10,20] and in children with Down-syndrome r111. _ _ ABR parameters depend on gestational age and on myelination. Both absolute and interpeak latencies decrease with increasing postnatal age, but contrary results have been published on maturation of ABRs as a function of birthweight [25]. Weight-related investigations [3,8,22,23] have mainly been performed in small-for gestational age newborns. Up to now, no investigations of ABRs were published concerning infants of diabetic mothers (IDMs). As histopathologic findings [9] point to a delayed myelination in infants born to diabetic mothers, we put forward the hypothesis for the present investigation that intrauterine environmental factors in IDMs may influence myelination in the central nervous system and thereby affect impulse transmission. Patients and Methods This investigation has been part of a larger project evaluating the neurological integrity of high-risk neonates. The study protocol was approved by the Ethical Committee of the Free University Berlin; parental informed consent was obtained for each neonate included in the study. IDMs with known risk factors for cochlear or brain stem damage (n = 19) like peri- or postnatal hypoxia (e.g. meconium aspiration, umbilical artery pH < 7.2, hypothermia < 36.O”C), mechanical ventilation, intracranial haemorrhage, haemolytic disease and hyperbilirubinaemia requiring exchange transfusions or a family history of hearing loss were excluded (n = 19), but not infants suffering from hypoglycemia. Thirty-nine IDMs were examined prospectively. According to White’s classification (Table I), the mothers of 17 infants belonged to group A, 10 to group B, 8 to group C and 4 to group D. Thirty-two healthy fullterm infants born during the same period of time after unremarkable pregnancy, labour and delivery served as control group. According to the study protocol, normal cranial ultrasound scans were obtained before performing ABR measurements.
TABLE I Classification of the severity of diabetes mellitus (DM) according to White (see Ref. 7). Class
Definition
A B C D
Treated by diet only Onset of DM when aged 20 or older, duration < 10 years Onset at lo-19 years of age or duration lo-19 years Onset before 10 years of age or duration >20 years or with background retinopathy or hypertension Proliferative retinopathy or vitreous haemorrhage Nephropathy; more than 500 mg/day proteinuria Both criteria fullfilled Arteriosclerotic heart disease Renal transplant
R F R/F H T
223
We collected the following data in all newborns: umbilical artery pH, birthweight, length, head circumference, Apgar-score, and neurological status according to Schlack [26]. Total bilirubin levels were measured as clinically indicated, this was the case in 36 children. In addition, the average maternal insulin requirement (White group B-D) during the last week of pregnancy was calculated and the maximum amniotic fluid insulin concentrations were measured (RIA, Pharmacia Diagnostics AB, Uppsala, Sweden) when clinically indicated. Gestational age of the infants was calculated from the first day of the mother’s last menstrual cycle and from ultrasonographic assessment of the biparietal diameter during the first trimester. In one case, these data were not available and gestational age was determined postnatally using somatic criteria according to Finnstrom [4]. Because of the wide range of the gestational age between 257 and 294 days, we transformed the birthweight into relative values (birthweight ratio), i.e. the birthweight divided by the gestational age specific 50th percentile according to Keen and Pearse [12]. The conceptional age was defined as the sum of gestational age plus age after birth. It ranged from 37 to 41 weeks. The auditory brain stem evoked responses were measured after stabilising blood sugar levels, since during or shortly after periods of hypoglycaemia, changes in ABR were described in infants and children by Koh et al. [15]. ABRs were recorded after feeding and during spontaneous sleep within the first two weeks of life using a portable Nicolet Compact Four (CA 2000, Nicolet Biomedical Instruments Inc., Madison, WI, USA). ABR testing was performed using rarefaction clicks (100 psec) at a rate of 11.4/set delivered through ear tips connected to a tubal insert phone set (TIP-300/C-300, Nicolet Biomedical Instruments, Madison, WI). One-channel bioelectric activity was recorded using gold cup electrodes attached to vertex (Cz) and earlobes (Al/A2) with the forehead serving as ground (Fpz). Interelectrode impedance was 30 dB, n
f 0.25 f 0.27 f 0.31 ?? 0.09 f 0.05 0
2.83 7.91 5.08 0.29 0.19
f 0.31 zk 0.32 f 0.27 zt 0.08 ?? 0.05 0
2.73 7.88 5.15 0.27 0.20
1
2.77 7.89 5.12 0.24 0.21
0.26 0.32 0.27 0.10 ?? 0.07
zt f f zt
3
2.72 7.90 5.18 0.25 0.20
Left
Right
Right
Left
White B-D (n = 22)
White A (n = 17)
f 0.16 zt 0.32 f 0.37 & 0.05 + 0.06
Infants of diabetic mothers
There are no significant differences between the groups using analysis of variance with conceptional age as co-variable. ‘Measurements at 70 dB.
1
2.85 7.92 5.12 0.25 0.22
0.23 0.30 0.33 0.06 ?? 0.05
2.87 7.96 5.07 0.24 0.22
Wave I latency (ms)a Wave V latency (ms)a I-V interval (ms)a Amplitude wave I (pV)” Amplitude wave V (pV)”
f + f zt
Left
Control infants (n = 32) Right
Measurement
Auditory brain stem response measurements (mean * S.D.).
TABLE III
f 0.19 f 0.34 f 0.08 f 0.05
?? 0.33
226
ratios were significantly higher in IDMs. The mean values for head circumference were significantly higher only in White A IDMs than in control infants, including gestational age as co-variable in the analysis of variance. On the contrary, the birthlength related to gestational age did not show any significant differences between the three groups. Peak serum total bilirubin levels were < 340 pmol/l in all infants, exceeding 255 kmol/l only in four infants in the subgroup White A and in three infants in the subgroup White B-D. ABR parameters depend essentially on the maturity, but may also depend on elevated serum bilirubin level [ 161. Therefore, we calculated the regression between interpeak latency wave I-V and peak serum bilirubin level with conceptional age as the second variable (multiple regression analysis). No significant relation could be proved between this ABR parameter and the serum total bilirubin level. Amniotic fluid insulin concentrations were available for 23 IDMs. The maxima ranged between 2.3 and 17.1 pU/l. There was no significant correlation between these values and the measured ABR parameters (bivariate linear regression, covariable gestational age). ABR results are listed in Table III. The three groups did not differ with respect to ABR measurements. The absolute latency values for waves I and V in the control group are somewhat longer than commonly found [ 181. This fact is presumably due to marking technique. Discussion
It is not yet clear to what extent maternal metabolism during pregnancy affects further development and mental abilities of the IDMs. Rizzo et al. [24] found a correlation between maternal metabolism and later intelligence. However, significant bias must be considered as for example perinatal asphyxia. Mimouni et al. [ 191have observed perinatal asphyxia in 27% of the infants born to mothers suffering from diabetes B through R. In the present study, however, IDMs with perinatal asphyxia, intracranial haemorrhage and other risk factors for auditory impairment were excluded. Nevertheless, the increased birthweight ratio typical for IDMs was found in subgroup White A as well as in subgroup White B-D. It was not accompanied by changes of the latencies or amplitudes of the ABR. The ABR parameter did not differ between IDMs and control infants. We speculate that in our population, myelination of the auditory tract had not been affected by maternal diabetes or that there were only minor alterations which could not be detected by ABR parameters. Our results may be explained by improved glucose monitoring and optimal metabolic control of diabetic mothers. The fact that newborns do not show measurable differences in ABR conventional parameters, does not exclude the possibility that such differences may appear later in life. Our results are in agreement with Petersen [23] who recorded visual evoked potentials (VEP) in 20 fullterm IDMs and did not find any differences in VEP latency and VEP amplitude between healthy fullterm infants and IDMs. Further investigations have to be performed in order to find possible relations between maternal diabetes, the degree of fetal macrosomia, hypoxia and glucose homeostasis and later development of the central nervous system.
221
Acknowledgements This work was supported by Deutsche Forschungsgemeinschaft SFB 174/A9. We are grateful to Boris Metze for assisting us in realizing the statistical calculations. References 1 2 3 4 5 6 7 8 9
10 11 12 13
14 15 16 17 18 19 20 21 22
23
Barden, T.P. and Pelzmann, P. (1980): Newborn brain-stem auditory evoked responses and perinatal clinical events. Am. J. Obstet. Gynecol., 136, 912-919. Despland, P.A. and Galambos, R. (1980): The auditory brain stem response (ABR) is a useful diagnostic tool in the intensive care nursery. Pediatr. Res., 14, 154-158. Fawer, C.L. and Dubowitz, L.M.S. (1982): Auditory brainstem responses in neurologically normal preterm and fullterm infants. Neuropediatrics, 13, 200-206. Finnstrom, 0. (1972): Studies on maturity in new-born infants. II. External characteristics. Acta Paediatr. &and., 61, 24-32. Galambos, R. and Hecox, K.E. (1978): Clinical applications of the auditory brain stem response. Otolaryng. Chn. N. Am., 11,709-722. Hakamada, S., Watanabe, K., Hara, K. and Migazaki, S. (1981): The evolution of visual and auditory evoked potentials in infants with perinatal disorder. Brain Dev., 3, 339-344. Hare, J.W. and White, P. (1980): Gestational diabetes and the White classification. Diabetes Care, 3, 394. Henderson-Smart, D.J., Pettigrew, A.G., Campell, D.J. (1983): Clinical apnea and brain-stem neural function in preterm infants. New Engl. J. Med., 308, 353-357. Homm, C. (1990): Gliazelldifferenzierung und Myehnisierung im fetalen Rlckenmark. Immunbiologische Untersuchungen bei akuter und chronischer Plazentainsufftzienz. Inaugural-Disseratation, Berlin. Joint Committee on Infant Hearing 1990 (1991): Position statement. AAP News, 4, 6-14. Kaga, K. and Marsh, R.R. (1986): Auditory brain stem responses in young children with Downsyndrome. Int. J. Pediatr. Otorhi., 11, 29-38. Keen, D.V. and Pearse, R.G. (1988): Weight, length and head circumference curves for boys and girls of between 20 and 42 weeks’ gestation. Arch. Dis. Child., 63, 1170-l 172. Ken-Dror, A., Pratt, H., Zeltzer, M., Sujor, P. Katzir, J. and Benderley, A. (1987): Auditory brain stem evoked potentials to clicks at different presentation rates: estimating maturation of preterm and fullterm neonates. Electroencephalogr. Clin. Neurophysiol., 68, 209-218. Kileny, P. and Robertson, C.M.T. (1985): Neurological aspects of infant hearing assessment. J. Otolaryngol., 14, 34-39. Koh, T.H.H.G., Aynsley-Green, A., Tarbit, M. and Eyre, U.A. (1988): Neural dysfunction during hypoglycaemia. Arch. Dis. Child., 63, 1353-1358. Lenhardt, M.L., McArthur, R. and Bryant, B. (1984): Effects of neonatal hyperbihrubinemia on the brain-stem electric response. J. Pediatr., 104, 281-284. Marshal, R.E., Reichert, T.J., Kerley, S.M. and Davis, H. (1980): Auditory function in newborn intensive care unit patients revealed by auditory brain stem potentials. J. Pediatr., 96, 731-735. Maurer, K., Leitner, H. and Schafer, E. (1982): Akustisch evozierte Potentiale (AEP). Ferdinand Enke Verlag, Stuttgart 1982, 99 pp. Mimouni, F., Miodomic, M., Siddiqi, T., Khury, J. and Tsang, R.C. (1988): Perinatal asphyxia in infants of insulin-dependent diabetic mothers. J. Pediatr., 113, 345-353. Oro, AS., Dixon, S.D. (1987): Perinatal cocaine and methamphetamine exposure: Maternal and neonatal correlates. J. Pediatr., 111, 571-578. Perlman, M., Feinmesser, P., Sohmer, H., Tamari, H., Wax, Y., Persmer, B. (1983): Auditory nervebrain-stem evoked responses in hyperbilirubinemic neonates. Pediatrics, 72, 658-664. Pettigrew, A.G., Edwards, D.A. and Henderson-Smart, D.J. (1985): The influence of intra-uterine growth retardation on brain stem development of preterm infants. Dev. Med. Child Neurol., 27, 467-472. Petersen St., Ryds, 0. and Trojaborg, W. (1990): Visual evoked potentials in term light-forgestational-age infants of diabetic mothers. Early Hum. Dev., 23, 85-91.
228
24
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