Unexpected Versus Anticipated Cystic Periventricular Leukomalacia

ABSTRACT

The objective of this study is to contrast the clinical profile of premature infants who develop cystic periventricular leukomalacia (cPVL) following a severe hemodynamic event (anticipated) with infants whose cPVL is not preceded by such an event (unexpected). The study design is a Retrospective Cohort. The study setting is a Neonatal Intensive Care Unit. Infants born at a gestational age of 23-32 weeks received serial cranial ultrasounds to screen for cPVL. Infants were divided into two groups based upon whether or not they had experienced a hemodynamic event of sufficient severity to potentially cause cPVL. Details of the clinical profile of these two groups were compared. Cystic PVL occurred in 27 infants (2.1%). In 15 infants (56%) cPVL was antipicated as there was at least one severe preceding hemodynamic event. Twelve infants (44%) had not experienced such an event and the discovery of cPVL on routine cranial ultrasound was unexpected. These infants were more likely to have been born to mothers who had received tocolytics (67 versus 13%, p = 0.004), prenatal steroids (67 vs. 27%, p = 0.038), and intrapartum antibiotics (92 vs. 20%, p < 0.001) and were more likely to have been delivered more than 6 hours after arrival to the hospital (83 vs. 40%; p = 0.038) than infants whose cPVL was anticipated. The diagnosis of clinical chorioamnionitis was also more common in the group of infants whose cPVL was unexpected (50 vs. 13%, p = 0.038). Almost half (44%) of our cases of cPVL occurred unexpectedly in infants who did not appear to have an obvious cause, as they had not experienced a severe hemodynamic event. These infants were more commonly delivered to mothers who had been hospitalized long enough to have received a variety of prenatal therapies and more often had a diagnosis of chorioamnionitis.

KEYWORD

Periventricular leukomalacia - newborns - premature infants

REFERENCES

• 1 Leviton A, Paneth N. White matter damage in preterm newborns-an epidemiologic perspective.  Early Hum Dev . 1990;  24 1-22
• 2 Volpe J J. Neurobiology of periventricular leukomalacia in the premature infant.  Pediatr Res . 2001;  50 553-562
• 3 Perlamn J M. White matter injury in the premature infant: an important determination of abnormal neurodevelopmental outcome.  Early Hum Dev . 1998;  53 99-120
• 4 Whitaker A H, Feldman J F, Van Raceme R. et al . Neonatal cranial ultrasound abnormalities in low birth weight infants: Relation to cognitive outcomes at six years of age.  Pediatrics . 1996;  98 719-727
• 5 Paneth N, Rudelli R, Monte W. et al . White matter necrosis in very low birth weight infants: Neuropathologic and ultrasonographic findings in infants surviving six days or longer.  J Pediatr . 1990;  116 975-984
• 6 Kuban K, Sanocka U, Leviton A. et al . White matter disorders of prematurity: Association with intraventricular hemorrhage and ventriculomegaly.  J Pediatr . 1999;  134 539-546
• 7 Bejar R, Wozniak P, Allard M. et al . Antenatal origin of neurologic damage in newborn infants.  Am J Obstet Gynecol . 1998;  159 357-363
• 8 Perlman J M, Risser R, Broyles R S. Bilateral cystic periventricular luekomalacia in the premature infant: associated risk factors.  Pediatrics . 1996;  97 822-827
• 9 Dubowitz L MS, Bidder G M, Mushin J. Developmental sequence of periventricular leukomalacia.  Arch Dis Child . 1985;  60 349-355
• 10 Pidcock F S, Graziani L J, Stanke C. et al . Neurosonographic features of periventricular echodensities associated with cerebral palsy in preterm infants.  J Pediatr . 1990;  116 417-422
• 11 Rogers B, Msall M, Owens T. et al . Cystic periventricular leukomalacia and type of cerebral palsy in preterm infants.  J Pediatr . 1994;  125 51-58
• 12 Leviton A, Paneth N, Reuss M L. et al . Maternal infection, fetal inflammatory response, and brain damage in very low birth weight infants.  Pediatr Res . 1999;  46 566-575
• 13 Dammann O, Leviton A. Maternal intrauterine infection, cytokines, and brain damage in the preterm newborn.  Pediatr Res . 1997;  42 1-8
• 14 Romero R, Gomez R, Ghezi F. et al . A fetal systemic inflammatory response is followed by the spontaneous onset of preterm parturition.  Am J Obstet Gynecol . 1998;  179 186-193
• 15 Gomez R, Romero R, Ghezzi F. et al . The fetal inflammatory response syndrome.  Am J Obstet Gynecol . 1998;  179 194-202
• 16 Pape K, Wigglesworth J S. Haemorrhage, ischaemia, and the perinatal brain.  Clin Dev Med . 1979;  69/70 11-38