Clinical and CSF studies in newborn infants with neurological abnormalities.

Thirty-four infants with abnormal neurological signs of no specific aetiology and 49 infants without abnormal neurological signs were selected in the newborn period. After a detailed neurological examination, the hyperexcitability syndrome was diagnosed in 18 and the apathy syndrome in 16 infants. The apathy syndrome was associated with apnoeic attacks, absent sucking, swallowing, and Moro responses as well as pneumonia. The hyperexcitability syndrome was associated with a history of fetal distress, a very poor condition at birth, and also absent sucking and swallowing responses. 3 infants with the apathy syndrome died. The majority of abnormal infants had either blood-stained or xanthochromic CSF. Cisternal puncture was helpful in diagnosing intracranial haemorrhage and was associated with subsequent clinical improvement in 6 infants. Though there was an association between apathy and hyperexcitability syndromes in the newborn period and subsequent neurological abnormalities during the first year, these abnormalities were present only in a minority. This study shows that the clinical diagnosis of the apathy or hyperexcitability syndrome in the newborn period has diagnostic and prognostic significance.