Cystic periventricular leukomalacia and type of cerebral palsy in preterm infants,☆☆,,★★

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Abstract

A case series design was used to identify cases of cystic periventricular leukomalacia (N = 31) identified by neurosonography at one regional tertiary intensive care nursery. Patients were preterm infants born at ≤32 weeks of gestation who had cysts involving predominantly the middle-posterior or posterior periventricular regions. Neurodevelopmental evaluations were made for 26 (96%) of 27 survivors. All infants assessed had cerebral palsy (i.e., 54% quadriplegia, 42% diplegia, and 4% hemiplegia). Most cognitive delays and all sensory impairments occurred in children with quadriplegia. Periventricular cysts were most extensive on parasagittal, anteroposterior views. The parasagittal, anteroposterior extent of periventricular cysts was most accurate in predicting the type and severity of motor and cognitive disabilities. Quadriplegia was associated with larger and more extensive cysts. (J PEDIATR 1994;125:S1-8)

Section snippets

METHODS

A case series design was used for study purposes. The study population consisted of preterm infants born at ≤32 weeks of gestation who were hospitalized at one regional tertiary neonatal center that serves eight counties of western New York State. The enrollment period extended from January 1988 to December 1991. A retrospective chart review was conducted to identify all neonates with a diagnosis of periventricular leukomalacia. In addition, neonatal discharge summaries and intensive care

RESULTS

A total of 1239 infants born at ≤32 weeks of gestation were admitted to the intensive care nursery between January 1988 and December 1991; 48 (4%) of these infants had a discharge diagnosis of PVL. Of the 48 infants, 17 were excluded from further analysis for the following reasons: no neonatal scans (n = 3), lost neonatal scans (n = 2), normal findings on cranial ultrasound studies (n = 2), presence of a choroid plexus cyst (n = 1), diagnosis of transient hyperechoic lesions (n = 4),

DISCUSSION

Although cystic PVL is a relatively uncommon complication in premature infants, it is a valuable marker for cerebral palsy. Periventricular cysts are usually bilateral and located at or near the trigone region. Developmental sequelae, including type of cerebral palsy, degree of functional motor deficits, and associated disabilities, are closely linked with the location and extent of cystic PVL.

Cranial ultrasonography remains the procedure of choice for the diagnosis of PVL in premature infants.4

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      White-matter damage is the most common form of brain injury, and periventricular leukomalacia (PVL) is a typical type of brain damage in premature infants [9,10]. Periventricular leukomalacia increases the risk of developing a variety of neurological sequelae, including motor dysfunction, delayed cognitive development, visual impairment, and epilepsy [11–13]. Qualitative studies in preterm neonates have reported high rates of periventricular leukomalacia, basal ganglia lesions, and thalamic lesions [14–16].

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    From the Departments of Pediatrics, Radiology, and Social and Preventive Medicine, State University of New York at Buffalo, School of Medicine and Biomedical Sciences

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    Supported in part by the Children's Guild of Buffalo, N.Y., and the New York State Office of Mental Retardation and Developmental Disabilities (RF 150-6619 D).

    Reprint Requests: Brian Rogers, MD, Robert Warner Rehabilitation Center of the Children's Hospital of Buffalo, 936 Delaware Ave., Buffalo, NY 14209.

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    0022-3476/94/$3.00 + 0 9/73/55237

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