Risk factors for isolated periventricular leukomalacia in very low birth weight infants: a case-control study

Periventricular leukomalacia [PVL] is a major cause of neurological disabilities in preterm newborn infants. PVL can occur as isolated [iPVL] or associated with massive intraventricular-preivenfricular hemorrhage [grade 3 and grade 4 IVH]. This study aimed to determine the antenatal and neonatal risk factors associated with iPVL. We retrospectively studied the medical record of very low birth weight infants [birth weight of less than 1500 gm], delivered at King Abdulaziz Medical City-Riyadh [KAMC-CR] and admitted to the neonatal intensive care of KAMC-CR between Jan 2004 and Dec 2008. A total of 696 VLBW infants were born alive in the study period, 20 infants developed iPVL, with prevalence of 2.87%. Neonates that have grade 3 IVH, grade 4 IVH, or major congenital malformation were excluded. The 20 affected infant with iPVL [iPVL group] were compared with 98 VLBW infants without 1PVL [No iPVL group] from the same cohort. At multivariate logistic regression model, larger birth weight odd ratio [OR]: 0.22; 95% confidence interval [CI]:0.059-0.82; P value: 0.024, early neonatal hypotension that needs therapy by a second inotropes like dobutamine [OR: 6;95%, CI:1.23-29. 17; P value:0.031]. The delay in surgical closure of hemodynamic significant PDA [hsPDA] [OR :0.8, 95% Cl :0.7-0.9, P value:0.002], occurrence of neonatal sepsis [OR:1.38; 95%CI:1.03-1.84; p value:0.031], retinopathy of prematurity [ROP] [OR:2. 77, 95% CI:1.12-6.83; P value:0.026] were associated with an increased risk of iPVL. In conclusion, early hypotension, neonatal sepsis, hsPDA and the delay of its surgical closure are strong risk factors for iPVL