RESUMO
This study comprised 103 preterm infants with a gestational age less than 33 weeks who were born in Tampere University Hospital and who were followed up to two years of age. Sixty-four perinatal variables were compared to ultrasound findings in the neonatal period and neurologic handicap at the age of two years. Duration of hypocarbia (PCO2 < or = 30 mmHg) during the first 72 h and hyperbilirubinemia (the mean level of serum total bilirubin) at three days of age were independently and significantly related to periventricular leukomalacia, but not directly to cerebral palsy. The only perinatal variables related independently and significantly to cerebral palsy at two years of age were periventricular leukomalacia and ventriculomegaly. According to these results, periventricular leukomalacia was the main predictor of cerebral palsy in preterm infants. In addition to hypocarbia, hyperbilirubinemia may also be involved in the pathogenesis of extensive (severe cystic) periventricular leukomalacia.
Assuntos
Paralisia Cerebral/epidemiologia , Hiperbilirrubinemia/complicações , Hipocapnia/complicações , Recém-Nascido Prematuro , Leucomalácia Periventricular/complicações , Gasometria , Paralisia Cerebral/etiologia , Feminino , Finlândia/epidemiologia , Seguimentos , Idade Gestacional , Hospitais Universitários , Humanos , Hiperbilirrubinemia/sangue , Hipocapnia/sangue , Recém-Nascido , Leucomalácia Periventricular/diagnóstico , Leucomalácia Periventricular/patologia , Modelos Logísticos , Masculino , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores de TempoAssuntos
Hemorragia Cerebral/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Leucomalácia Periventricular/diagnóstico por imagem , Masculino , Avaliação de Resultados em Cuidados de SaúdeRESUMO
During a twelve-month period five cases of extensive periventricular leukomalacia (PVL) in preterm infants with a gestational age of 31-32 weeks were diagnosed by routine ultrasound screening of preterm infants. The perinatal courses and later development of these infants were compared with 12 other infants with a comparable gestational age born during the same time period. PVL babies were delivered more often by the vaginal route (p = 0.0034), and their mean highest serum total bilirubin value was significantly higher (p = 0.0054) than that of the control infants. The mean value of the highest blood pH during the first 72 hours of life was also significantly higher (p = 0.0311) in PVL babies than in control babies. On the basis of these results we speculate that in addition to ischaemia in the periventricular area, bilirubin toxicity may play an additional role in the severe damage seen in extensive periventricular leukomalacia.
