Relationship of Ultrasonographic Findings and Neurologic Outcomes in Infants with Birth Weight of Less than 2,000gm

Yang, Seong Won; Choi, Jung Hwan; Yun, Chong Ku

Abstract

PURPOSE
In premature, neurologic sequelae is most important long-term complication. So we investigated the relationship between brain ultrasonographic findings and neurologic outcome.
METHODS
Infants weighting less than 2,000gm who were discharged from the Neonatal Intensive Care Unit of Seoul National University Children's Hospital from Jan 1, 1989 to Dec. 31 1992, were investigated. All ultrasound images were examined for evidence ICH/IVH, periventricular echogenicity, and cystic PVL. Infants were assessed neurodevelopmentally in the neonatal period and at least until 12 months corrected for gestation age.
RESULTS
1) Total 291 infants were discharged, but expired, against medical advice discharged, and lost follow-up infants were exculded, 187 infants were investigated for the realtionship between brain ultrasonographic findings and neurologic outcomes. 2) The proportion of infants with neurologic sequelae (cerebral palsy) according to birth weight was as follow: 4 cases (50%) of less than 1,000gm; 13 cases (24.5%) of between 1,001gm and 1,500gm; 11 cases (5.6%) of between 1,501gm and 2,000gm, 3) The proportion of infants with neurologic sequelae according to intraventricular hemorhage (IVH) was as follows : no IVH, 1 cases (1.4%) of 69 case; IVH gradeI, 9 cases (16.1%) of 56 cases; IVH grade II, 9 cases (17%) of 53 cases; grade III, 5 cases (55.6%) of 9 cases. 4) The proportion of infants with neurologic sequelae according to the degree of periventricular echogenisity (PVE) was as follows : normal PVE, none of 53 cases; transient increased PVE, 1 case (2.5%) of 40 cases; persistent increased PVE, 6 cases (8.3%) of 72 cases; cystic periventricular leukomalacia (PVL), 17 cases (77%) of 22 cases. 5) Mantel-Haenszel chi-square analysis for the relationship between IVH and PVE showed significant correlation (p<0.05). 6) Linear logistic regression analysis for risk factors of neurologic sequelae showed that low birth weight and PVE were significant factors (p<0.05), but IVH was not significant factor (p>0.05). 7) The severity and nature of neurologic sequelae correlated with the locations and the severity of cystic PVL.
CONCLUSIONS
These data suggest that low birth weight and PVL are risk factors of neurologic sequelae, and location and extent of PVL correlate with severity and type of neurologic sequelae. So early detection and follow-up examination of PVL by brain ultrasonography are needed for early detection of neurologic sequelae and minimization of handicaps.