DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20183520

Early periventricular leukomalacia in preterm neonates

Saurabh Kapoor, Ravi Sharma, Anilkumar Sapare, Rajiv Aggarwal

Abstract


Background: Preterm neonates are at increased risk for brain injury. More than 10% will sustain neurological injuries leading to significant learning disabilities, motor developmental delay, cerebral palsy, seizures and mental retardation. Periventricular leukomalacia (PVL) is the most common form of white matter injury of prematurity. The objective of the present study was to identify the incidence of early periventricular leukomalacia (PVL) and its associated risk factors in the study group.

Methods: All preterm neonates with either Gestational age <32weeks and/or Birth weight <1500 grams who were admitted to Neonatal Intensive Care Unit within the period of 1st November 2013 to 30th April   2015 were taken for study. A total of 112 babies met the inclusion criteria but 104 were finally taken into the study. Screening of intraventricular haemorrhage and early PVL changes in VLBW babies was done by neurosonogram on day 3 and day 14 of life by a single well qualified radiologist. Follow up cranial ultrasound was done weekly for the babies who were diagnosed to have IVH and/or PVL by day 14 of life.

Results: The incidence of early periventricular leukomalacia in very low birth weight babies in present study was 7.7%. It was seen that 87.5% babies had periventricular flares and 12.5% babies had cystic changes. It was seen that birth weight<1000grams (OR 0.006; CI:0.00-0.50; p value 0.023) and neonatal sepsis (OR 80.9; CI:1.65-3947.6;p value 0.027) significantly increased the risk of developing PVL in VLBW babies. The duration of hospital stay was found to be significantly increased in babies having PVL.

Conclusions: The incidence of early periventricular leukomalacia in babies born <32weeks gestation and/or birth weight<1500grams is 7.7%. Birth weight <1000 grams and neonatal sepsis were found to increase the risk of periventricular leukomalacia in these babies.


Keywords


Incidence, Periventricular leukomalacia, Risk factors

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References


Behnke M, Eyler FD, Garvan CW, Tenholder MJ, Wobie K, Woods NS. Cranial ultrasound abnormalities identified at birth: their relationship to perinatal risk and neurobehavioral outcome. Pediatr. 1999;103(4):e41.

Canpolat FE, Yurttutan S. Cranial ultrasonography in neonatal intensive care unit: Neonatologists Perspective. Med J Islamic World Acad Sci. 2011;19(3):117-20.

Vollmer B, Roth S, Baudin J, Stewart AL, Neville BG, Wyatt JS. Predictors of long-term outcome in very preterm infants: gestational age versus neonatal cranial ultrasound. Pediatr. 2003;112(5):1108-14.

Gleason CA, Devaskar SU. Periventricular Leukomalacia: Neonatal Neuroimaging. In: Avery's diseases of the newborn. 9th ed. Philadelphia: Saunders; 2012;59:834.

Perlman JM. White matter injury in the preterm infant: an important determination of abnormal neurodevelopment outcome. Early Hum Dev. 1998;53(2):99-120.

Routine screening cranial ultrasound examinations for the prediction of long term neurodevelopmental outcomes in preterm infants. Paediat and Child Health. 2001;6(1):39-43.

Silveira RC, Procianoy RS. Ischemic brain damagein very low birth weight preterm newborn infants. J Pediatr. 2015;81(1):S23-32.

Lee HJ, Park SH, Na KH, Park SY, Kim EY, Kim KS et al. Developmental assessment of preterm infants at two years of age with periventricular leukomalacia. J Korean Soc Neonatol. 2002;9(2):167-75.

Zupan V, Gonzalez P, Lacaze-Masmonteil T, Boithias C, d'Allest AM, Dehan M, et al. Periventricular leukomalacia: risk factors revisited. Dev Med Child Neurol. 1996;38(12):1061-7.

Stevenson DK, Wright LL, Lemons JA, Oh W, Korones SB, Papile LA. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1993 through December 1994. Am J Obstet Gynecol. 1998;179(1):1632-9.

Barría RM, Flandez A. Parenchymatous Brain Injury in Premature Infants: Intraventricular Hemorrhage and Periventricular Leukomalacia, Neonatal Care. 2012.

Al Tawil KI, El Mahdy HS, Al Rifai MT, Tamim HM, Ahmed IA, Al Saif SA. Risk factors for isolated periventricular leukomalacia. Pediatr Neurol. 2012;46(3):149-53.

Tsuji M, Saul JP, du Plessis A, Eichenwald E, Sobh J, Crocker R, et al. Cerebral intravascular oxygenation correlates with mean arterial pressure in critically ill premature infants. Pediatr. 2000;106(4):625-32.