Clinical analysis of periventricular venous cerebral infarction in 16 premature infants / 中华围产医学杂志

ABSTRACT

Objective:To summarize the clinical features and risk factors of periventricular venous cerebral infarction (PVI) in premature infants to prompt an early diagnosis.Methods:Clinical data of 16 premature newborns diagnosed with PVI by ultrasound in the Department of Pediatrics of Peking University Third Hospital from January 1, 2013, to December 31, 2018, were retrospectively collected. The clinical manifestations, ultrasound findings, risk factors and outcomes were analyzed. Two allocations were performed to the patients mild PVI group ( n=5) or severe PVI group ( n=11) according to the degree of brain injury suggested by ultrasound findings; and typical PVI group (onset time was 6-96 h after birth; n=14) or atypical PVI group (onset time was less than 6 h or more than 96 h after birth; n=2) according to the onset time. Chi-square or Fisher's exact test was used to analyze the differences in high risk factors and prognosis between the groups. Univariate and multivariate logistic regression analysis were used to analyze the high risk factors related to different groups. Correlations of the severity of brain injury and the onset time with PVI prognosis were analyzed using univariate analysis. Results:(1) The gestational age of the 16 infants with PVI was 25 +2-33 +1 weeks (median 27 weeks). The birth weight ranged from 660 g to 1 760 g (median 1 065 g). All cases showed PVI under ultrasongraphy one week after birth, among which 11 was diagnosed and the other five were misdiagnosed as periventricular intraventricular hemorrhage Grade Ⅲ. Five cases presented with convulsion, while the others did not show any specific symptoms. All cases were shown periventricular intraventricular hemorrhage GradeⅢ or above. Bilateral hemispheres were involved in seven cases, left hemisphere in five and right in four. There were 15 cases with massive infarction and six with midline displacement. Obstructive hydrocephalus occurred in six cases 4-25 d after birth, and eight patients had brain parenchyma softening 5-25 d after birth. (2) The incidence of asphyxia in the mild PVI group was lower than that in the severe PVI group (1/5 vs 10/11, P=0.013) and asphyxia was a high risk factor of severe PVI ( OR=40.000, 95% CI 1.982-807.100). (3) There was no significant difference in the clinical risk factors between the typical and atypical PVI groups (all P>0.05). (4) Among the 16 cases, nine died, one was lost to follow-up, five had delayed intelligence and motor development and one had normal growth and development. No significant difference in the prognosis (died or discharged after improvement) was found between the mild and severe PVI groups, or between the typical and atypical PVI groups ( P=0.365 or 0.700). Conclusions:PVI usually occurs in very or extremely low birth weight premature infants within one week after birth. Clinical manifestations of PVI include convulsions, but most are non-specific. Asphyxia may lead to severe PVI. PVI has a higher short-term mortality as well as a higher incidence of long-term neurological sequelae.