ABBREVIATIONS
cPVLCystic periventricular leukomalaciaThe aim of this systematic review was to study motor and cognitive outcome in infants with severe early brain lesions and to evaluate effects of side of the lesion, sex, and social economic status on outcome. A literature search was performed using the databases Pubmed and Embase. Included studies involved infants with either cystic periventricular leukomalacia (cPVL), preterm, or term stroke (i.e. parenchymal lesion of the brain). Outcome was expressed as cerebral palsy (CP) and intellectual disability (mental retardation). Median prevalence rates of CP after cPVL, preterm, and term stroke were 86%, 71%, and 29% respectively; of intellectual disability 50%, 27%, and 33%. Most infants with cPVL developed bilateral CP, those with term stroke unilateral CP, whereas after preterm stroke bilateral and unilateral CP occurred equally often. Information on the effects of sex and social economic status on outcome after specific brain lesions was very limited. Our findings show that the risk for CP is high after cPVL, moderate after preterm stroke, and lowest after term stroke. The risk for intellectual disability after an early brain lesion is lower than that for CP. Predicting outcome at individual level remains difficult; new imaging techniques may improve predicting developmental trajectories.It is well established that infants with a prenatal, perinatal, or neonatal lesion of the brain are at risk for neurodevelopmental disorders. In general, infants with the most extensive lesions are at highest risk for neuromotor disabilities, such as CP, and cognitive impairments. 1 However, some infants with an extensive brain lesion develop quite well, whereas some infants in whom brain imaging showed the presence of only a relatively small or no lesion may develop severe neurodevelopmental problems.2 Little is known on the neurodevelopmental sequelae of specific brain lesions. In addition, it has not been systematically studied whether an early lesion of the brain affects the motor and cognitive domains similarly. Neither is it clear whether the child's sex and social class affect the developmental sequelae of a lesion. In general, male sex and low social class are associated with a higher risk of adverse outcome, 2-4 but whether these factors modify the developmental effect of a lesion of the brain is uncertain.The aim of this systematic review is to assess developmental outcome in infants with the following specific lesions of the brain: cystic periventricular leukomalacia (cPVL) and neonatal stroke. For the latter lesion, we differentiated between lesions occurring at preterm age and those occurring around term age.5 Outcome will be specified as CP, including unilateral and bilateral forms, and as impaired cognitive outcome, expressed as intellectual disability (mental retardation). Specific attention will be paid to a potentially modifying effect of sex, social class, and the side of the lesion.
METHODA literature search was performed to identify studies published from ...