Periventricular leucomalacia and neurodevelopmental outcome in preterm infants.

Abstract

SUMMARY During an 18 month period, 120 preterm infants of 34 weeks' gestation or less were prospectively examined for periventricular leucomalacia (PVL) by cerebral ultrasound. Neurological and developmental assessment was carried out at 18 months of age corrected for prematurity in 82 surviving neonates. The developmental outcome (Griffiths development quotient) was above 80 and similar in infants with normal scans (n=41), isolated periventricularintraventricular haemorrhage (n=13), and post-haemorrhagic hydrocephalus (n=4), and no major handicap was diagnosed in these groups. By contrast, the prognosis was variable and poorer in infants with PVL (n=24) and depended on the extent and site of the lesion. Infants with frontal PVL (n= 13) developed normally. Major sequelae (n=8) were closely related to frontal-parietal PVL and frontal-parietal-occipital PVL and could be ascribed to the presence of cysts as well as to a persistent hyperechogenic ultrasonographic PVL appearance. A relation between size and site of the lesion and type and severity of the handicap was established.

The evolution and outcome of cavitating periventricular leukomalacia in infancy. A study of 46 cases

“…It is also apparent that discrete involvement of a single zone only is not associated with adverse outcome. These findings are largely in agreement with those of FAWER et al [8] who reported the outcome of 26 survivors with PVL and those of Cooke [4] who found that the presence of cystic lesions, particularly when bilateral, were strongly predictive of developmental delay. In general, the more mature infants who developed CPVL had the worst outcome.…”

“…Cyst size has been previously shown to be an accurate predictor of the extent of the neurological damage [8,10] and we have confirmed this finding. In 11 infants the largest cyst was less than 1 cm in diameter and eight (73%) of these infants had no evidence of cerebral palsy.…”

“…Recently a number of reports have been published documenting the frequency with which the condition is encountered [11,15] and the outcome of affected infants [2,3,6,7,8,17] but these studies have described relatively few infants. We have recently published follow up data on very low birth-weight (VLBW) infants with periventricular leukomalacia [9] but this is unrepresentative of the full spectrum of this condition.…”

Risk Factors of Sensorineural Hearing Loss in Preterm Infants

“…The follow-up examination consisted of a neurological ex amination [20], an assessment of development using Griffith's [21] scale and an evaluation of vision and hearing according to Sheridan [22,23]. Auditory brainstem response (ABR) and cerebral ultrasound were performed with conventional techniques [5,7,[24][25][26][27][28], In our unit, ABR testings were performed before discharge in all infants who had one or more of the following risk factors: congenital malformations, congenital familial deafness, birth weight < 1,000 g. hypcrbilirubinaemia with exchange transfusion, con genital infections, prolonged acidosis (arterial or capil lary pH < 7.2 lasting more than 2 h). neonatal seizures, meningitis, prolonged aminoglycoside therapy and high peak or trough concentrations of aminoglyco sides.…”

Early Brain Damage and the Development of Motor Behaviorin Children: Clues for Therapeutic Intervention?

“…Some children recover completely, whereas others suffer from severe handicapping conditions (Costello et al, 1988;Ford et al, 1989 (Volpe, 1995). In preterm infants, it has been reported that frontally located lesions are associated with better outcomes than lesions located parietally or occipitally (Fawer et al, 1987;Fazzi et al, 1994).…”