Epilepsy is the frequent outcome of perinatal brain damage with term newborns. Studies looking at neurological outcome with prematurely born children are mainly oriented towards evaluation of motor development. It is now accepted that damage to brain-tissue partly occurs due to prenatal pathological events. It is the concluding process of brain cortex formation going on during the final trimester of pregnancy that opens possibility of secondary development of cortical brain damage following the primary exposure of white matter. The present research was aimed at establishing whether antenatal developed periventricular damage to brain-tissue with premature babies can cause in early age onsets of epilepsy or of abnormally altered bioelectrical activity as a subclinical pointer of enlarged risk for the onset of epilepsy later on. The research included 91 prematures born during years 1992-1994 in the Maribor Maternity Ward who underwent brain ultrasound during the first week and 14 children currently treated in the Zagreb Children's Clinic. On the basis of the medical documentation we retrogradly categorised their ultrasound readings according to the degree of brain damage and the approximate time of the occurence of the damage. The children were neurologically examined and their motor development was evaluated. Their electroencephalogram recordings and assembled data regarding the eventual occurence of epilepsy were classified. The potential prognostic factors were compared with the incidence of overt epilepsy or with abnormally altered bioelectrical brain activity. Using the binary logistic regression method, the relative risk of the occurence was established for each of the potential factors. 48.6 % of the children had a completely normal brain ultrasound. Instances of brain-tissue damage were localised in periventricular white matter. Non of the children had cortical damage ascertainable by ultrasound. In 19 % of our patients, an isolated haemorrhage brain-tissue lesion was found, in 15.2 % an isolated ischemic damage, in 17.1 % concurring hemorrhagic lesions were found. By ultrasound criteria, 37 % of the brain-damage occurences were established as antenatal. Severe brain lesions, defined as lesions of the third or fourth degree, were present in 11.4 % children, with an unfavourable outcome of motor development beingascertained most frequently in this group. During the 6-8 year of follow-up the cases up epilepsy was diagnosed in 11.4 % of our patients. The most frequent form of epilepsy was the West syndrome, occuring with 5.7 % of all patients from the 4th to 9th month of age. Gestational age, birth weight, presence of perinatal asphyxia and intrauterine growth retardation proved not to be statistically associated with epileptic seizures. The use of tocolytic therapy was correlated with the 3.4-fold relative risk of epilepsy, but the difference was not statistically significant. Correlation of subsequent epilepsy and of hemorrhagic as well as ischemic white matter damage, irrespective of the timing of the damage, proved to be statistically significant (p

The aim to this study was to find and determine diagnostic and prognostic value of ultrasound bain investigations in the group of risk new-borns eith different gestational ages for prediction of the abnormal neurological and cognitive development of child at the age of two years. Our results confirm significantly high prognostic value of definitely pathologic ultrasound finding. The comparison of diagnostic reliability of ultrasound brain investigation between the groups of new-borns with different gestational ages is very interesting and shows the highest reliability in the group of risk new-borns with the lowest gestational age. The ultrasound brain investigation has also high value for predicting abnormal development of child at the age of two in the group of term new-borns with certain pathologic ultrasound findings. Results of statistical analysis (method of multivariate logistic regression) show that definitely pathologic findings of ultrasound brain investigations are the most significant risk factors for abnormal development with cerebral palsy and disturbances in development of cognitive functions. Similar are conclusions of some recent studies of Norwegian authors about the role of the perinatal risk factors for the development of cerebral palsy. The ultrasound brain investigation of new-born at risk for later neurological abnormality has to be done in first four days after birth and has to be repeated according to pathology. With scheduled and carefully made ultrasound brain investigation of new-born, outlook of lesion can be precisely described and with help of perinatal history, etiopathogenesis of early brain damage sometimes can be reconstructed. Towsend and co-workers in their recently published study also recommended ultrasound brain investigation of premature newborns with different risks for impairment of neurological functions at the age of 1 month. Clinical investigation and an early ultrasound brain investigation were not alway enough for prediction neurological impairment. According to the results of our study, ultrasound brain investigation is recommended as screening procedure for term new-borns with different forms of risk for neurological impairment too, as 50% of children with cerebral palsy belong to the group of term newborns. Our study confirms the hypothesis that each early brain damage is followed by the processes of structural and functional reorganization. The processes of brain plasticity are most prominent in the group of premature new-borns with the lowest gestational age. Therefore, the group of premature new-borns with gestational age from 28 to 33 weeks are recognized as the "group with worst capability of brain plasticity or morphological reconstruction of an early brain damage".