Lenticulostriate vasculopathy in preterm infants: a new classification, clinical associations and neurodevelopmental outcome.

OBJECTIVE: To examine the inter-rater reliability for the diagnosis of LSV on cranial ultrasound (cUS), determine the risk factors associated with LSV and its progression, and examine neurodevelopmental outcome. STUDY DESIGN: Prospective case-control study of neonates ≤32wks of gestation assessed for LSV by serial cUS (n = 1351) between 2012 and 2014 and their neurodevelopment at 18-36mon-corrected age compared to controls. RESULTS: Agreement for LSV on cUS improved from Κappa 0.4-0.7 after establishing definitive criteria and guidelines. BPD was the only variable associated with the occurrence and the progression of LSV. Cytomegalovirus (CMV) infection occurred in one neonate (1.5%). Neurodevelopmental outcome of neonates with LSV did not differ from controls. CONCLUSIONS: Establishment of well-defined stages of LSV improves the reliability of the diagnosis and allows identification of neonates with progression of LSV. Although LSV was associated with BPD, it was not associated with congenital CMV infection.

Lenticulostriate vasculopathy in neonates: Perspective of the radiologist.

Lenticulostriate vasculopathy (LSV) is a diagnosis dependent on neonatal cranial ultrasound (US). The diagnosis of LSV requires the presence of linear or branching echogenicities in the area of the basal ganglia and/or thalamus on gray scale cranial US. Although the diagnosis of LSV is dependent on cranial US, there are no convincing correlates observed on either computerized tomography or magnetic resonance imaging. Moreover, the radiographic criteria for LSV on cranial US remain vague, and intra-observer correlations are generally reported to be poor. The purpose of this review is to examine the issues associated with the use of cranial US and the diagnosis of LSV, including alternative imaging, clinical abnormalities and the significance of LSV on cranial US.

Bone lesions in an infant with congenital parvovirus b19 infection.

Bone lesions on radiographs of newborns often suggest congenital infections. Skeletal roentgenograms are recommended in the evaluation of suspected congenital syphilis, but bone lesions have been recognized in other congenital infections. We report the case of an infant with hydrops fetalis secondary to congenital parvovirus B19 infection who was found to have bone lesions in multiple long and axial bones on admission to the neonatal ICU. Both the infant and her mother were evaluated for other causes of congenital infection, but no other agents were identified. The bone lesions had nearly completely resolved by 10 weeks of age. Screening of neonates with congenital parvovirus B19 infection for bone lesions may provide additional insight into the incidence and pathophysiology of these lesions.

Value of neurosonography in predicting subsequent cognitive and motor development in extremely low birth weight neonates.

OBJECTIVE: To compare the results of neurosonography (NSG) with subsequent neurodevelopmental testing in extremely low birth weight (ELBW; < or =1000 g) neonates. STUDY DESIGN: NSG at hospital discharge was available in 164 neonates and Bayley Scores of Infant Development (BSID II) evaluations (MDI and PDI) were performed in 158 of these infants at 18 to 22 months. Neurosonographic studies obtained prior to the discharge study also were evaluated. Neurosonograms were interpreted by pediatric radiologists, and BSID II examinations were performed by certified examiners masked to the results of the neurosonographic studies. RESULTS: A normal sonographic study at discharge was observed in 44% (14/32) of neonates with MDI <70 and 29% (7/24) with PDI <70. Furthermore, the sonographic study at discharge was normal in 59% (36/61) of neonates with MDI 70 to 84 and 56% (31/55) with PDI 70 to 84. Conversely, approximately 30 to 40% of those with an abnormality noted on neurosonogram at discharge, or at any time during hospitalization, had MDI and/or PDI scores > or =85. The association between abnormal NSG at discharge and low BSID II results was stronger for the PDI exam compared with the MDI exam. CONCLUSION: These results emphasize the limitations of NSG in predicting subsequent neurodevelopmental outcome in ELBW neonates. The primary role for NSG in ELBW neonates may be in the diagnosis and management of acute problems, such as intraventricular hemorrhage and posthemorrhagic hydrocephalus, and not as a tool to predict subsequent outcome.