Neonatal Med.  2020 May;27(2):51-56. 10.5385/nm.2020.27.2.51.

The Risk Factors of Periventricular Leukomalacia among Very Low Birth Weight Infants

Affiliations
  • 1Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

Abstract

Purpose
Periventricular leukomalacia (PVL) is an important morbidity in preterm infants. Its reported prevalence in very low birth weight (VLBW) infants is 3% to 15% in VLBW infants. PVL develop seizure disorder, intellectual disability, visual problem, and cerebral palsy. This study was done to describe the risk factors of PVL in VLBW infants.
Methods
Medical records of 172 VLBW infants at Inje University Ilsan Paik Hospital neonatal intensive care unit were reviewed retrospectively from January 2010 to December 2014. Patients were divided into the non­PVL group (n=155) and the PVL group (n=17). The PVL group included both cystic and non­cystic forms. Demographic findings and factors associated with PVL were compared between these groups.
Results
The incidence of non­cystic and cystic PVL was 9.8%. The mean gestational age was significantly lower in the PVL group. The mean birth weight was not significantly different between the groups. The incidences of premature rupture of membrane and pregnancy induced hypertension were not significantly different between the two groups. The number of histologic chorioamnionitis was significantly higher in the PVL group (P<0.05). Other conditions such as respiratory distress syndrome, patent ductus arteriosus, early­onset sepsis, and hypotension were not significantly different between the two groups. The incidence of intravascular hemorrhage (IVH) (grade ≥3) was more significant in the PVL group (P<0.05). Multiple logistic regression analysis indicated that histologic chorioamnionitis (odds ratio [OR], 6.3; 95% confidence interval [CI], 1.1 to 36.3) and IVH (grade ≥3) (OR, 16.9; 95% CI, 1.9 to 153.1) were significant risk factors of PVL.
Conclusion
Histologic chorioamnionitis and IVH (grade ≥3) increase the risk of PVL in VLBW infants. Strategies to prevent these conditions could attenuate the incidence of PVL.

Keyword

Leukomalacia; Periventricular; Infants, premature

Reference

1. Khwaja O, Volpe JJ. Pathogenesis of cerebral white matter injury of prematurity. Arch Dis Child Fetal Neonatal Ed. 2008; 93:F153–61.
2. Blumenthal I. Periventricular leucomalacia: a review. Eur J Pediatr. 2004; 163:435–42.
3. Kusters CD, Chen ML, Follett PL, Dammann O. ''Intraventricular'' hemorrhage and cystic periventricular leukomalacia in preterm infants: how are they related? J Child Neurol. 2009; 24:1158–70.
4. Rocha G, Proenca E, Quintas C, Rodrigues T, Guimaraes H. Chorioamnionitis and brain damage in the preterm newborn. J Matern Fetal Neonatal Med. 2007; 20:745–9.
5. Herzog M, Cerar LK, Srsen TP, Verdenik I, Lucovnik M. Impact of risk factors other than prematurity on periventricular leukomalacia. A population-based matched case control study. Eur J Obstet Gynecol Reprod Biol. 2015; 187:57–9.
6. Al Tawil KI, El Mahdy HS, Al Rifai MT, Tamim HM, Ahmed IA, Al Saif SA. Risk factors for isolated periventricular leukomalacia. Pediatr Neurol. 2012; 46:149–53.
7. de Vries LS, Eken P, Dubowitz LM. The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res. 1992; 49:1–6.
8. Volpe JJ. Neurology of the newborn. 5th ed. Philadelphia: Elsevier;2008.
9. Counsell SJ, Allsop JM, Harrison MC, Larkman DJ, Kennea NL, Kapellou O, et al. Diffusion-weighted imaging of the brain in preterm infants with focal and diffuse white matter abnormality. Pediatrics. 2003; 112(1 Pt 1):1–7.
10. Korean Neonatal Network database. Very low birth weight infants in 2014 [Internet]. Seoul: KNN;c2017. [cited 2020 May 11]. Available from: http://www.knn.or.kr/index.jsp.
11. Korean Neonatal Network database. Very low birth weight infants in 2015 [Internet]. Seoul: KNN;c2017. [cited 2020 May 11]. Available from: http://www.knn.or.kr/index.jsp.
12. Korean Neonatal Network database. Very low birth weight infants in 2016 [Internet]. Seoul: KNN;c2017. [cited 2020 May 11]. Available from: http://www.knn.or.kr/index.jsp.
13. Inder TE, Wells SJ, Mogridge NB, Spencer C, Volpe JJ. Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study. J Pediatr. 2003; 143:171–9.
14. Section II: Medical care of the preterm infants. In : Malcolm WF, editor. Beyond the NICU. New York: McGraw-Hill Education;2015.
15. Hatzidaki E, Giahnakis E, Maraka S, Korakaki E, Manoura A, Saitakis E, et al. Risk factors for periventricular leukomalacia. Acta Obstet Gynecol Scand. 2009; 88:110–5.
16. Chau V, McFadden DE, Poskitt KJ, Miller SP. Chorioamnionitis in the pathogenesis of brain injury in preterm infants. Clin Perinatol. 2014; 41:83–103.
17. Wu YW, Colford JM Jr. Chorioamnionitis as a risk factor for cerebral palsy: a meta-analysis. JAMA. 2000; 284:1417–24.
18. Resch B, Vollaard E, Maurer U, Haas J, Rosegger H, Muller W. Risk factors and determinants of neurodevelopmental outcome in cystic periventricular leucomalacia. Eur J Pediatr. 2000; 159:663–70.
19. Denzler A, Burkhardt T, Natalucci G, Zimmermann R. Latency after preterm prelabor rupture of the membranes: increased risk for periventricular leukomalacia. J Pregnancy. 2014; 2014:874984.
20. Yim SY, Yang CY, Park JH, Kim MY, Shin YB, Kang EY, et al. Korean Database of Cerebral Palsy: a report on characteristics of cerebral palsy in South Korea. Ann Rehabil Med. 2017; 41:638–49.
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