The whole spectrum of cystic periventricular leukomalacia of the preterm infant: results from a large consecutive case series

Resch, Bernhard; Resch, Elisabeth; Maurer-Fellbaum, U.; Pichler-Stachl, Elisabeth; Riccabona, Michael; Hofer, Nora; Urlesberger, Berndt

doi:10.1007/s00381-015-2786-3

Cited by 27 publications

(29 citation statements)

References 25 publications

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“…Although cPVL and IVH have high association and both contribute to increased risk of CP and cognitive impairment [4,10], few studies have reported neurodevelopmental outcomes of cPVL-affected infants with or without IVH. A previous study investigating IVH and developmental outcomes showed that extremely preterm infants with IVH and white matter lesions did not have increased risk of neurodevelopmental impairment than those with white matter lesions alone [25].…”

Section: Discussionmentioning

confidence: 99%

“…Because cPVL may not develop until 3-6 weeks after birth [2,4], infants with complete ultrasound data (serial ultrasound scans recorded during the first 2 months of life until discharge) were included for analysis. Infants who died before 28 days after birth or did not receive complete ultrasound examinations were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Approximately 40-70% of cPVL are associated with different grades of intraventricular hemorrhage (IVH) in preterm infants [4,5]. IVH happens mostly within 48-72 h after birth [6] and is graded with increasing severity [7].…”

Section: Introductionmentioning

confidence: 99%

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Isolated Cystic Periventricular Leukomalacia Differs from Cystic Periventricular Leukomalacia with Intraventricular Hemorrhage in Prevalence, Risk Factors and Outcomes in Preterm Infants

Wang

Lin²,

Tu³

et al. 2016

Neonatology

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Background: Cystic periventricular leukomalacia (cPVL) is the most severe white matter injury and is often associated with intraventricular hemorrhage (IVH) in preterm infants. Objective: The aim of this study was to investigate the prevalence, risk factors and neurodevelopmental outcomes of isolated cPVL and cPVL with low-grade and high-grade IVH in premature infants. Methods: From 2001 to 2012, 9,964 infants with <31 weeks' gestational age (GA) admitted to Taiwan hospitals were enrolled. cPVL was classified into three groups: isolated cPVL, cPVL with low-grade (I/II) IVH, and cPVL with high-grade (III) IVH. Results: Of 7,805 infants with complete ultrasound data, 286 (3.7%) had cPVL. Among the cPVL infants, 93 (32.5%) were isolated, 118 (41.3%) had low-grade IVH and 75 (26.2%) had high-grade IVH. The risk of cPVL with IVH was significantly higher among infants with <27 weeks' GA than those with ≥27 weeks' GA, in contrast to that of isolated cPVL. Using infants without cPVL and IVH as the reference group, the most significant predictor of isolated cPVL was neonatal sepsis (odds ratio 2.39; 95% confidence interval 1.52-3.77), while 5-min Apgar score <5 (2.50; 1.48-4.21) and prolonged mechanical ventilation (2.19; 1.42-3.42) were associated with cPVL with low-grade IVH, and GA <27 weeks (2.63; 1.56-4.42), pneumothorax (3.04; 1.40-6.65) and prolonged mechanical ventilation (3.36; 1.88-6.01) contributed to cPVL with high-grade IVH. cPVL infants with low-grade and high-grade IVH had a higher risk of abnormal neurodevelopmental outcomes than infants with isolated cPVL at the age of 24 months. Conclusions: Isolated cPVL, cPVL with low-grade IVH and cPVL with high-grade IVH had different risk factors and neurodevelopmental outcomes, suggestive of different causal pathways.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Isolated Cystic Periventricular Leukomalacia Differs from Cystic Periventricular Leukomalacia with Intraventricular Hemorrhage in Prevalence, Risk Factors and Outcomes in Preterm Infants

Wang

Lin²,

Tu³

et al. 2016

Neonatology

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“…Thus, clinical studies focused on the association of risk for periventricular leukomalacia in PPROM exposed very preterm neonates: PPROM especially before 20-22 weeks of gestation is clearly associated with an increased risk for periventricular lesions as an independent factor apart from the degree of prematurity [6,8]. Longterm follow up of preterm neonates suffering from periventricular leukomalacia following among others PPROM confirm the serious consequences with respect neurodevelopmental impairments: cerebral palsy in 84 % and mental retardation in about 50 % was described in a large cohort from an Austrian singlecenter study using strictly defined neonatal and follow-up variables [10].…”

mentioning

confidence: 87%

Preterm Premature Rupture of Membranes: A Constant Challenge in Perinatal Medicine?

Gortner¹

2016

Klin Padiatr

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Two recently published observational studies have focused on the outcome of very preterm respectively of very low birth weight infants after preterm premature rupture of fetal membranes (PPROM). One single center study from the Netherlands enrolling 160 women with PPROM before 24 weeks gestational age, who admitted to the Rotterdam Medical Center between 2002 and 2011, were analyzed 14. In parallel, there was a publication from the German Neonatal Network (GNN) enrolling about 6,000 very low birth weight infants, whose data were analyzed under the aspect of PPROM as a potential risk factor for adverse neonatal outcomes 5.

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“…There is evidence to suggest an inverse relationship between the degree of impairment and the gestational age at birth. An estimated 3% of infants born before 32 weeks of gestation have visual impairment, with an incidence of 53% in those with known PVL . Bilateral isolated hearing loss is reported at 2–3 years of age in 2.2% of children born before 28 weeks of gestation .…”

Section: The Link Between Preterm Birth and Perinatal Fetal Brain Injurymentioning

confidence: 99%

Use of magnesium sulfate in preterm deliveries for neuroprotection of the neonate

Usman

Foo

Tay

et al. 2017

The Obstetric & Gynaecologis

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Key content The prevalence of preterm birth is increasing and owing to advances in neonatal care, more infants are surviving. However, in parallel with this, the incidence of cerebral palsy (CP) is also rising. Magnesium sulfate (MgSO4) is currently recommended for use in women who are at risk of giving birth at less than 30–32 weeks of gestation for neuroprotection of their infants. The exact mechanism of action remains unclear. Meta‐analyses report encouraging results that are consistent with a modest but tangible benefit for the use of MgSO4, and suggest a number needed to treat (NNT) to prevent one in 46 cases of CP in infants born preterm before 30 weeks of gestation and one in 63 cases of CP in infants born preterm before 34 weeks of gestation. Learning objectives To gain an understanding of the risk of neurodisability in infants delivered preterm. To become familiar with the main studies assessing the use of MgSO4 for neuroprotection in preterm deliveries. To become aware of the relevant international guidelines. Ethical issues Concerns have been raised regarding the higher number of perinatal deaths reported with the use of MgSO4 in the MagNET study. This was not substantiated in the Cochrane review. Given that MgSO4 is a safe, readily available and inexpensive drug, even if there were only to be modest benefits from its use, the risk–benefit ratio is in favour of its use.

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The whole spectrum of cystic periventricular leukomalacia of the preterm infant: results from a large consecutive case series

Abstract: Long-term neurodevelopmental outcome of bilateral PVL always was adverse and different from unilateral PVL. The latter might be negatively influenced by associated intra- and periventricular haemorrhages.

Cited by 27 publications

References 25 publications

Isolated Cystic Periventricular Leukomalacia Differs from Cystic Periventricular Leukomalacia with Intraventricular Hemorrhage in Prevalence, Risk Factors and Outcomes in Preterm Infants

Isolated Cystic Periventricular Leukomalacia Differs from Cystic Periventricular Leukomalacia with Intraventricular Hemorrhage in Prevalence, Risk Factors and Outcomes in Preterm Infants

Preterm Premature Rupture of Membranes: A Constant Challenge in Perinatal Medicine?

Use of magnesium sulfate in preterm deliveries for neuroprotection of the neonate

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