Screening cranial ultrasounds were performed on 115 very low birthweight infants during the first week of life. Fourteen infants (12%) developed changes of periventricular leukomalacia. All 14 weighted 1100 g or less at birth. Eight infants' initial studies were normal, four had intraventricular hemorrhage, and two had periventricular echo densities. Cystic periventricular leukomalacia developed between 17 and 104 days of age and occurred later in those infants whose initial study was normal. There were tone abnormalities in 11 of the 12 infants who received developmental follow-up. Severe cognitive delays were common in the older infants. This study demonstrates the need for late ultrasound screening even in the presence of initial normal ultrasound examinations.

The physiologic and neurodevelopmental benefits of developmentally sensitive nursing care for high-risk infants have been well documented. The remaining challenge is to find ways to introduce developmental care principles into busy intensive care nurseries. The article discusses the development of three clinical pathways designed around five areas for developmental intervention: environmental organization, structuring of nursing care, feeding, family involvement, and family education. Each pathway incorporated developmental principles appropriate for a different level of care; the level III pathway was designed for acutely ill or very premature infants, the level II pathway for infants recovering from acute illness or older premature infants, and the level I pathway for full-term infants. Introduction of the developmental care pathways had an immediate positive impact in the tertiary level intensive care nursery at Allegheny General Hospital.