Neurodevelopmental outcomes of children with cystic periventriculai leukomalacia / 国际儿科学杂志

Cystic periventricular leukomalacia( cPVL) is the main nerve pathological change that affects the long-term neurodevelopment outcome in preterm infants,which may result in cerebral palsy,epilepsy,cogni-tive and audio-visual disorder. cPVL lacks specific symptoms,the diagnosis of cPVL mainly depends on cranial ultrasound,CT and MRI. This review briefly introduces the changes of brain imaging of cPVL and the neurode-velopmental outcomes of cPVL.

Neurodevelopmental outcomes of children with cystic periventriculai leukomalacia / 国际儿科学杂志

Cystic periventricular leukomalacia( cPVL) is the main nerve pathological change that affects the long-term neurodevelopment outcome in preterm infants,which may result in cerebral palsy,epilepsy,cogni-tive and audio-visual disorder. cPVL lacks specific symptoms,the diagnosis of cPVL mainly depends on cranial ultrasound,CT and MRI. This review briefly introduces the changes of brain imaging of cPVL and the neurode-velopmental outcomes of cPVL.

Risk Factors of Cystic Periventricular Leukomalacia in Preterm Infants with Gestational Ages of Less Than 32 Weeks according to Gestational Age Group / 대한주산의학회잡지

PURPOSE: The aim of the study was to determine the incidence of cystic periventricular leukomalacia (PVL) and identify the risk factors for cystic PVL in preterm infants with gestational age (GA) less than 32 weeks according to gestational age group. METHODS: The medical records and brain imaging were reviewed for preterm infants with less than 32 weeks GA who lived more than 4 weeks and admitted to the neonatal intensive care unit at Inje University Sanggye Paik Hospital from January 2009 to June 2015. We determined the incidence and the risk factors for the development of cystic PVL in preterm infants according to GA group. RESULTS: Incidence of cystic PVL was 15.1% (26/172). Multivariate analysis showed that intraventricular hemorrhage (IVH) [P=0.006, odds ratio (OR) 5.478, 95% confidence interval (CI) 1.641-18.285), oxygen uses over 28 days (P=0.025, OR 3.086, 95% CI 1.152-8.264), and NEC (P=0.042, OR 3.731, 95% CI 1.047-13.333) were independent risk factors for the developmental of cystic PVL. Subgroup analysis showed that pregnancy-induce hypertension and IVH were independent risk factors in preterm infants with GA of less than 28 weeks. Also, oxygen uses over 28 days and culture proven sepsis were independent risk factors in preterm infants with GA of 28(+0)-31(+6) weeks. CONCLUSION: These results suggest that pregnancy-induce hypertension and IVH may increase the risk for the subsequent development of cystic PVL in preterm infants with GA of less than 28 weeks, and oxygen uses over 28 days and culture proven sepsis may increase in preterm infants with GA of 28(+0)-31(+6) weeks.

Risk Factors of Cystic Periventricular Leukomalacia in Preterm Infants with Gestational Ages of Less Than 32 Weeks according to Gestational Age Group / 대한주산의학회잡지

PURPOSE: The aim of the study was to determine the incidence of cystic periventricular leukomalacia (PVL) and identify the risk factors for cystic PVL in preterm infants with gestational age (GA) less than 32 weeks according to gestational age group. METHODS: The medical records and brain imaging were reviewed for preterm infants with less than 32 weeks GA who lived more than 4 weeks and admitted to the neonatal intensive care unit at Inje University Sanggye Paik Hospital from January 2009 to June 2015. We determined the incidence and the risk factors for the development of cystic PVL in preterm infants according to GA group. RESULTS: Incidence of cystic PVL was 15.1% (26/172). Multivariate analysis showed that intraventricular hemorrhage (IVH) [P=0.006, odds ratio (OR) 5.478, 95% confidence interval (CI) 1.641-18.285), oxygen uses over 28 days (P=0.025, OR 3.086, 95% CI 1.152-8.264), and NEC (P=0.042, OR 3.731, 95% CI 1.047-13.333) were independent risk factors for the developmental of cystic PVL. Subgroup analysis showed that pregnancy-induce hypertension and IVH were independent risk factors in preterm infants with GA of less than 28 weeks. Also, oxygen uses over 28 days and culture proven sepsis were independent risk factors in preterm infants with GA of 28(+0)-31(+6) weeks. CONCLUSION: These results suggest that pregnancy-induce hypertension and IVH may increase the risk for the subsequent development of cystic PVL in preterm infants with GA of less than 28 weeks, and oxygen uses over 28 days and culture proven sepsis may increase in preterm infants with GA of 28(+0)-31(+6) weeks.

Risk Factors for Cystic Periventricular Leukomalacia in Very Low Birth Weight Infants

PURPOSE: In the present study, we aimed to determine the risk factors for the development of cystic periventricular leukomalacia (CPVL) in very low birth weight (VLBW) infants. METHODS: We reviewed the medical records of 309 infants weighing less than 1,500 g who were admitted to the neonatal intensive care unit at Hanyang University Medical Center, Seoul from April 2007 to December 2012. Thirty-nine infants died within 28 days of birth. Of the remaining 270 infants, 21 with CPVL established by cranial ultrasonography, and 63 without CPVL, who were matched for gestational age, were enrolled in this study. Univariate and multivariate analyses of maternal, perinatal, and neonatal risk factors for CPVL were performed through retrospective assessment of data collected from the medical records. RESULTS: Necrotizing enterocolitis (NEC > or =stage II: 42.9% vs. 9.5%, P=0.002), culture-proven sepsis (66.7% vs. 34.9%, P=0.021), hypotension with sepsis (33.3% vs. 6.3%, P=0.004), and severe intraventricular hemorrhage (> or =grade III: 61.9% vs. 22.2%, P=0.002) were associated with the development of CPVL on univariate analysis. Using multivariate logistic regression analysis, two variables were found to be statistically significant independent risk factors: NEC (> or =stage II: adjusted OR, 5.12; 95% CI, 1.219-21.514; P=0.026) and hypotension with sepsis (adjusted OR, 8.23; 95% CI, 1.194-56.713; P=0.032). CONCLUSION: NEC (> or =stage II) and hypotension with sepsis were associated with an increased risk of developing CPVL in VLBW infants.

Incidence and Risk Factors for Cystic Periventricular Leukomalacia in Premature Low Birth Weight Infants

PURPOSE: While the survival rate of preterm infants in the neonatal intensive care unit is increasing, the neurological complication such as cerebral palsy is still a serious problem. This study is to determine the incidence of cystic periventricular leukomalacia (cPVL) observed among preterm low birth weight infants and its risk factors. METHODS: The medical records of infants (under 37 weeks of gestational age and under 2,500 g of birth weight) delivered from June 2003 to May 2006 were reviewed with special reference to cPVL. Maternal factors, labor and delivery characteristics and neonatal parameters were collected. It is inquired of whether the already known perinatal and neonatal risk factors such as prematurity, birth weight, intrauterine infection, mode of delivery, breech presentation, postnatal resuscitation and intubation, antenatal steroid, administration of surfactant and early onset of sepsis can be attributed to cPVL incidence of given infants. RESULTS: Ventilator care was offered to 7 infants, and surfactant was applied to 6 infants among 10 infants who has cPVL. The incidence of cPVL is 7.2%. The risk factors like low Apgar score at 1 minute, twin, use of epinephrine or dopamine, postnatal administration of surfactant and ventilator care have statistical meaning (P<0.05). CONCLUSION: The incidence of cPVL is higher in the cases of low Apgar score at 1 minute, twin, delivery room resuscitation, respiratory distress syndrome and ventilator care. These risk factors should be controlled with special attention to their influences on the brain. By way of regular follow-up, careful observation of neurological problem must be given to infants required of epinephrine, dopamine and ventilator care.

A Study on the Incidence and Risk factors of Cystic Periventricular Leukomalacia in very Low Birth Weight Infants

PURPOSE: Our study was carried out to estimate the incidence of cystic periventricular leukomalacia (CPVL) and to identify the risk factors for CPVL. METHODS: The medical records and cranial ultrasound scan were reviewed for 321 infants weighing less than 1, 500 g who lived more than 28 days and admitted to the NICU at Samsung Medical Center from October 1995 to December 2001. A multiple logistic regression was performed to identify which factors were independently associated with CPVL. RESULT: CPVL developed in 19 (5.9%) infants of 1, 188+/-236 g birth weight and 28(+6)+/-2(+4) weeks gestational age. Incidence of CPVL according to birth weight and gestational age were as follows respectively: <750 g 5.3%, 750-999 g 5.5%, 1, 000-1, 249 g 3.9%, 1, 250-1, 499 g 7.9% and <25weeks 8.3%, 25-26weeks 6.7%, 27-28weeks 6.5%, 29-30weeks 2.7%, 31-32weeks 11.1%. The mean day of diagnosis of CPVL was 41+/-33 days. Univriate analysis indicate that two clinical variables, prolonged ventilator duration (CPVL: control, 35+/-64 days vs 17+/-26 days, P=0.0184) and severe intraventricular hemorrhage (IVH) (21% vs 2.7%, P=0.0324), were significant predictors of CPVL. The odds ratio estimate and 95% confidence limits are 1.012 and 1.003 to 1.022, respectively for prolonged ventilator duration; 2.6 and 1.044 to 6.602, respectively for severe IVH. CONCLUSIONS: These data suggest that prolonged ventilator duration and severe IVH increase the risk for development of CPVL.

Risk Factors for Cystic Periventricular Leukomalasia and Neurologic Outcomes According to Cranial Ultrasonography in Preterm Infants

PURPOSE: The aim of the study was to determine the risk factors for the development of cystic periventricular leukomalacia (PVL) in preterm infants and the neurologic outcomes according to its extent and site of cystic PVL. METHODS: Forty-four preterm infants whose a gestational age ranging from 25 to 34 weeks with cystic PVL documented by cranial ultrasonography and other forty-four preterm infants without brain abnormality were enrolled in this study. We determined perinatal and neonatal risk factors for the development of cystic PVL in these infants. The forty-four preterm infants with cystic PVL were divided into two groups according to extent and site of cystic change by cranial ultrasonographic findings. Infants were included in localized group when the extent of cystic change was localized in one lobe and in diffuse group when the extents of cystic change was located in more than two lobes. We compared the differences of the perinatal and neonatal risk factors and neurologic outcomes according to its extent and site of cystic PVL between the two groups. RESULT: Neonatal sepsis was the only significant risk factor for the development of cystic PVL (P<0.05). There were no significant differences of perinatal and neonatal risk factors between infants with localized cystic PVL and diffuse cystic PVL. Diffuse cystic PVL was diagnosed earlier than localized cystic PVL (P<0.05). Cerebral palsy and convulsion were more common in infants with diffuse cystic PVL than localized cystic PVL (P<0.05), and infant with the involvement of occipital lobe showed high risk of cerebral palsy. CONCLUSION: With the more diffuse extents of cystic PVL and when the cystic change in occipital lobe, the risk of neurologic problem was high. And diffuse cystic PVL was diagnosed earlier than localized cystic PVL.