Hand Tremors in Premature Infants: What Parents Should Know

Tremors in premature infants?

Dear Dr.
Pei,
My child was born prematurely, two months early, on June 6, 2017.
As of today, the corrected age is 6 months and 20 days.
In the past month, I have noticed that my child's hands are shaking involuntarily, with the left hand shaking more noticeably than the right, which shakes slightly but is still perceptible.
The shaking stops when I apply pressure, but I am unsure if this is because my pressure is greater than the shaking force, which makes it seem like the shaking has ceased.
I have read that this condition may be related to the immature development of the infant's nervous system.
I am concerned and seeking your guidance for clarification.
Thank you!

Nai Nai, 50~59 year old female. Ask Date: 2018/02/26

Dr. Pei Rensheng reply Pediatrics

Hello,
Neurodevelopmental disorders in premature infants primarily arise from two categories:
1.
Intraventricular Hemorrhage (IVH): Intraventricular hemorrhage is a specific type of brain hemorrhage that occurs in premature infants.
The incidence increases as the birth weight decreases; approximately 20-25% of all premature infants experience IVH, while the incidence can be as high as 45% in those weighing between 500-750 grams.
This is a significant concern for neonates, especially for preterm infants.
The clinical symptoms of IVH are often subtle and may not be easily recognized.
Symptoms include decreased alertness, apnea, seizures, and less typical signs such as altered consciousness, irritability, vomiting, tachypnea, unstable temperature, reduced activity, and decreased muscle tone.
Long-term outcomes are most notably associated with hydrocephalus and cerebral palsy, while other potential sequelae include visual impairment, hearing loss, speech delays, intellectual disabilities, feeding difficulties, incontinence, and epilepsy.
Parents of premature infants should regularly take their children for pediatric check-ups to detect issues early and seek solutions promptly.
2.
Periventricular Leukomalacia (PVL): Periventricular leukomalacia refers to the damage of brain tissue in premature infants due to factors such as hypoxia or insufficient blood flow, leading to reduced blood supply to the white matter surrounding the lateral ventricles and resulting in tissue necrosis and various clinical deficits.
This complication is more common in infants weighing less than 1500 grams, with an incidence of about 20%.
Since the lesions occur in the white matter adjacent to the lateral ventricles, it is termed periventricular leukomalacia.
The symptoms of PVL are also not easily noticeable; however, if a neonatologist suspects that a low-birth-weight infant is at risk for PVL, they will schedule regular cranial ultrasound examinations for early diagnosis.
Sometimes, PVL may be mild and not detectable on ultrasound, so parents must monitor their child's developmental milestones.
If the infant is unable to lift their head by three to four months, exhibits increasing stiffness in the lower limbs, or shows signs of scissoring of the legs, there may be a possibility of PVL.
Mild cases of PVL typically only affect the lower limbs, with normal speech and cognitive development, allowing for normal interactions in school.
In more severe cases, all limbs may be stiff, and there may be associated epilepsy, intellectual disabilities, hearing impairments, and speech delays.
If these issues are detected early, parents should seek assistance from a pediatric neurologist, who can utilize imaging tools such as ultrasound and MRI for early diagnosis.
Wishing you health and happiness!
Dr.
Ren-Sheng Pei, Attending Physician, Pediatrics, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2018/02/26

More Info

Understanding hand tremors in premature infants can be a source of concern for many parents, especially when they notice unusual movements in their child's hands. In your case, your child was born two months premature and is currently at a corrected age of 6 months and 20 days. The observation of hand tremors, particularly when they are more pronounced in one hand than the other, can understandably raise questions about your child's neurological development.

Firstly, it is important to recognize that tremors in infants, especially those born prematurely, can be relatively common and often related to the immaturity of the nervous system. Premature infants are at a higher risk for various neurological issues due to their early birth, which can affect the development of their brain and motor skills. The tremors you are observing may be a result of this immaturity, and they can manifest as involuntary shaking or trembling of the hands.

The fact that the tremors stop when you apply pressure to the hands is a positive sign. This behavior suggests that the tremors are likely not due to a severe underlying condition but rather a temporary manifestation of neurological immaturity. In many cases, as the infant's nervous system matures, these tremors will diminish and eventually resolve completely. It is also worth noting that many infants exhibit some degree of tremors, especially during periods of excitement or fatigue.

However, it is essential to monitor the situation closely. If the tremors persist, worsen, or are accompanied by other concerning symptoms, such as developmental delays, difficulty feeding, or changes in muscle tone, it would be prudent to consult with your pediatrician or a pediatric neurologist. They can conduct a thorough evaluation to rule out any potential neurological disorders or other underlying issues.

In addition to seeking medical advice, there are several supportive measures you can take at home to help your child. Engaging in gentle, age-appropriate activities can promote motor development and provide sensory stimulation. Activities such as tummy time, reaching for toys, and gentle massage can help strengthen your child's muscles and improve coordination.
Furthermore, creating a calm and soothing environment can also be beneficial. Reducing overstimulation from loud noises or bright lights may help minimize the frequency of tremors. Ensuring that your child is well-rested and not overly tired can also contribute to their overall well-being.

In summary, while hand tremors in premature infants can be concerning, they are often a normal part of neurological development. As your child grows and their nervous system matures, these tremors are likely to decrease. However, maintaining open communication with your healthcare provider is crucial to ensure that your child's development is on track and to address any concerns you may have. Remember, every child develops at their own pace, and with time and support, many of these early challenges can be overcome.

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