Is It a New Syndrome or Due to Overstimulation in the ICU?

To the Editor.— A recent article by Perlman and Volpe in Pediatrics1 described a new syndrome of movement disorder in infants with severe bronchopulmonary dysplasia. I should like to take issue with these findings and feel that what Perlman and Volpe are describing is actually infants responding behaviorally to an overstimulating environment. This "new syndrome" is, I feel, what Als calls "the consequence of a mismatch of extrauterine environment and the capacity of the central nervous system of the fetal neonate which is adapted for an intrauterine existence"2 to deal with the onslaught of stimulation which it encounters in the noisy, chaotic environment of the average Neonatal Intensive Care Unit. The behaviors described in the article are seen routinely in preterm infants responding behaviorally to overstimulation.3 These behaviors become learned maladaptive responses to stress. They can be prevented or ameliorated by the provision of a more supportive environment, one which recognizes early signs of behavioral disorganization and responds by reducing the cause of the overstimulation, be it auditory, visual, tactile, or kinesthetic.4-6