8-month old son

  Our 8-month old son was born 10 weeks premature.  Suffered respiratory distress upon birth.  On repirator for two weeks, some oxygen supplied for remainder of total 8-week stay in NICU.  Hypotnia a concern from first week after birth.  Diagnosed IVH, Level I on right, Level II on left.  Swellng of ventricals led to spinal tap.  Spinal fluid clean, so tap was considered of little value.  Swelling stopped and was no longer an immediate concern.
  Hypotonia continues 8 months after birth.  He does a "corkscrew" roll when lying on back, but does not yet roll all the way over to stomach.  Very little trunk strength.  Can hold his head up for a few minutes when chest supported in upright position.  Can lift his head high when laid on his stomach.  (Tends to want to arch his back and lay his head way back toward his spine, even when held or placed in a seated position with back support.)  Despite this delayed gross motor development, he continues some fine motor skills seem to be developing: reaching for and grasping toys, just recently lifting his feet in front of him and grabbing feet with hands.
  Hearing may be a problem.  Otoacoustical emissions testing was inconclusive but suggested some hearing loss for high frequency sound.
  Social and personal development seems to be on track.
  Last week, first MRI of his head suggests that he has a generalized lack of myelin in his brain, and more than would be expected from his premie status.
  We are certainly hoping that this is not a demyelinating condition.  I am just beginning my search for information.  Would like whatever information I can get about hypomyelination or delayed myelination.  Are there good outcomes to starts like our son's?
Dear George:
Sorry to hear about your son.  The fact that your son was premature, had a respiratory insult that required intubation and mechanical ventillation, had a bleed in his head (although thankfully not grade III or IV), it is not unusual for a history such as this to give a hypotonic picture.  The most important thing right now is to get your son into early intervention, physical therapy, occupational therapy to maximize his gross motor and fine motor skills.  Second, I think it is important that you know for sure about his hearing and his vision.  Third, I would make sure that who ever read the MRI was someone who is familiar with premie children and developmental myelination on MRI.  Without examining you son, it is very difficult to assess his hypotonia and motor skills.  So, I am sorry that I can not make a really qualified statement concerning the hypomyelination and the complications thereby resulting.  I think the best thing to do is gather all the information, and see a good pediatric neurologist.  Get
plugged into early intervention.  After things have been well evaluated, then you can make a better decision concerning possible future problems.  As far as hypomyelination versus demyelination, the first is likely more probable.  These early hypoxic events usually have an adverse effect on the oligodendrocyte (the cell type that myelinates axons in the CNS).  Best of luck with you son, as your questions become more focussed, let us know and if we can help, we will.  Start off by seeing your neonatalogist for information about premies, CNS function etc.
Sincerely,
CCF Neuro[P] MD