Ultrasonographic Features and Severity Scoring of Periventricular Hemorrhagic Infarction in Relation to Risk Factors and Outcome

Bassan, Haim; Benson, Carol B.; Limperopoulos, Catherine; Feldman, Henry A.; Ringer, Steven A.; Veracruz, Elaine; Stewart, Jane E.; Soul, Janet S.; DiSalvo, D N; Volpe, Joseph J.; Plessis, Adré J. du

doi:10.1542/peds.2005-1570

Cited by 105 publications

(71 citation statements)

References 27 publications

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“…In our cohort, 30% of the infants with PVHI developed USCP, which is lower than reported previously (47-90%) (2,3,10,22). This might be explained by differences in baseline characteristics of the infants, especially the size and site of the PVHI, and differences in redirection of care.…”

Section: Discussioncontrasting

confidence: 82%

Neonatal DTI early after birth predicts motor outcome in preterm infants with periventricular hemorrhagic infarction

et al. 2015

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Background:To determine the association between early neonatal diffusion tensor imaging (DTI) and the development of unilateral spastic cerebral palsy (USCP) in preterm infants with periventricular hemorrhagic infarction (PVHI). Methods: Preterm infants with PVHI were assessed with early (≤4 wk after birth) and term-equivalent age MRI-DTI. Involvement of corticospinal tracts was assessed by visual assessment of the posterior limb of the internal capsule (PLIC) on DTI (classified asymmetrical, equivocal, or symmetrical) and by an atlas-based approach calculating fractional anisotropy asymmetry index in the PLIC. Motor outcome was assessed at ≥15 mo corrected age. results: Seven out of 23 infants with PVHI developed USCP. Their PLIC was visually scored as asymmetrical in 6 and equivocal in 1 on the early DTI. Thirteen out of 16 infants with a symmetrical motor development had a symmetrical PLIC on early DTI, the remaining 3 were equivocal. All infants with USCP had a fractional anisotropy asymmetry index of >0.05 (optimal cut-off value) on early DTI. In infants with a symmetrical motor development (n = 16), 14 had an asymmetry index ≤0.05 while 2 had an index >0.05. conclusion: DTI in preterm infants with PVHI within a few weeks after birth is associated with later motor development. P eriventricular hemorrhagic infarction (PVHI) is a serioustype of brain injury that occurs in around 1-3% of preterm infants with a gestational age below 37 wk (1-3). It is a complication of a germinal matrix hemorrhage that develops due to impaired venous drainage of the medullary veins in the periventricular white matter and may have an adverse effect on corticospinal tract (CST) development (4). PVHI leads in about 50-85% of infants to, mainly unilateral, spastic cerebral palsy (USCP) (2,3,5). The diagnosis is made with cranial ultrasound (cUS) and prediction of cerebral palsy is possible in most but not all infants taken the site and size of the lesion into account (5).MRI studies performed at term-equivalent age (TEA) will reliably predict motor outcome with asymmetry in myelination of the posterior limb of the internal capsule (PLIC) due to Wallerian degeneration being almost invariably associated with the development of USCP (6).Diffusion tensor imaging (DTI) allows the study of microstructural properties of the white matter (7). To the best of our knowledge, it has not yet been studied whether early disturbances in CST integrity shortly after the onset of PVHI relate to later development of USCP. In addition, the prognostic value of DTI for early prediction of USCP in infants with PVHI is still unknown.The aim of this study was to determine the association between MRI-DTI within 4 wk after birth and the development of USCP in preterm infants with PVHI. RESULTS PatientsThe clinical characteristics and motor outcome of the study group (n = 23) are summarized in Table 1. The infants who developed cerebral palsy (n = 7, 30%) all had USCP. Cranial Ultrasound FindingsIn 16 infants with a normal motor development, the cUS on which t...

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Section: Discussioncontrasting

confidence: 82%

Neonatal DTI early after birth predicts motor outcome in preterm infants with periventricular hemorrhagic infarction

et al. 2015

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“…19 A recent report suggests that periventricular hemorrhagic infarction is occasionally bilateral but, if so, is invariably asymmetric. 20 In the light of this information, we cannot exclude the possibility that a few of our patients with grade 4 intraventricular hemorrhage may have had bilateral periventricular hemorrhagic infarction rather than periventricular leukomalacia.…”

Section: Discussionmentioning

confidence: 87%

Factors Associated With Epilepsy in Children With Periventricular Leukomalacia

et al. 2007

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Children with cerebral palsy associated with periventricular leukomalacia frequently develop unprovoked epileptic seizures. This article reports an analysis of risk factors for epilepsy in children with radiologically confirmed periventricular leukomalacia. This cohort was screened for epilepsy and for an array of clinical and demographic factors. Of 154 subjects with radiologically confirmed periventricular leukomalacia, 40 (26.0%) had epilepsy. In the epileptic group, radiologic pathology other than periventricular leukomalacia was uncommon. Significant associations were found between epilepsy and cerebral palsy patterns other than spastic diparesis, mental handicap, cortical visual impairment, neonatal seizures, and severe periventricular leukomalacia. Only the presence of neonatal seizures was significantly associated with epilepsy once other risk factors were controlled in the regression model. Some previous studies have shown an association between neonatal seizures and later epilepsy for cerebral palsy in general. This is the first report of such an association for a single predominant type of cerebral pathology.

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“…13 However, some recent studies have challenged this notion, 14,15 whereas others 16 continue to support the benign nature of mild PIVH. On the other hand, severe grades of PIVH (grade 3 and 4) are well known to be associated with NDI, but there are significant variations in the reported outcomes, [17][18][19][20] which may lead to variability in counseling of long-term outcomes between practitioners. None of the previous reviews have systematically summarized neurodevelopmental outcomes of different grades of PIVH after adjusting for confounders and effect modifiers.…”

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confidence: 99%

Periventricular/Intraventricular Hemorrhage and Neurodevelopmental Outcomes: A Meta-analysis

2015

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CONTEXT: Periventricular/intraventricular hemorrhage (PIVH) is a common short-term morbidity in preterm infants, but its long-term neurodevelopmental impact, particularly with mild PIVH, remains unclear. STUDY SELECTION: Studies reporting long-term neurodevelopmental outcomes based on severity of PIVH were included.DATA EXTRACTION: Study characteristics, inclusion/exclusion criteria, exposures, and outcome assessment data extracted independently by 2 coauthors. RESULTS:The pooled unadjusted odds ratios of the primary outcome of death or moderate-severe neurodevelopmental impairment (NDI) were higher with both mild (1.48, 95% CI 1.26-1.73; 2 studies) and severe PIVH (4.72, 4.21-5.31; 3 studies); no studies reported adjusted odds ratios. Among survivors, odds of moderate-severe NDI were higher with mild and severe PIVH in both unadjusted (1.75, 1.40-2.20; 3 studies; 3.36, 3.06-3.68; 5 studies) and adjusted (1.39, 1.09-1.77; 3 studies; 2.44, 1.73-3.42; 2 studies) pooled analyses. Adjusted odds of cerebral palsy and cognitive delay were higher with severe but not mild PIVH.LIMITATIONS: Only observational studies were included. Fifteen of 21 included studies had a moderate-high risk of bias.CONCLUSIONS: Mild and severe PIVH are associated with progressively higher odds of death or moderatesevere NDI compared with no PIVH, but no studies adjusted for confounders. Among survivors, mild PIVH was associated with higher odds of moderate-severe NDI compared with no PIVH.

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Ultrasonographic Features and Severity Scoring of Periventricular Hemorrhagic Infarction in Relation to Risk Factors and Outcome

Cited by 105 publications

References 27 publications

Neonatal DTI early after birth predicts motor outcome in preterm infants with periventricular hemorrhagic infarction

Neonatal DTI early after birth predicts motor outcome in preterm infants with periventricular hemorrhagic infarction

Factors Associated With Epilepsy in Children With Periventricular Leukomalacia

Periventricular/Intraventricular Hemorrhage and Neurodevelopmental Outcomes: A Meta-analysis

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