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Late-onset cystic periventricular leukomalacia in premature infants: a threat until term
P André1, B Thébaud, J Delavaucoupet
1Service de Pédiatrie et Réanimation Néonatale, Hĵpital Antoine Béclère, Université Paris-Sud, Clamart, France.
Insights
Late-onset cystic periventricular leukomalacia can develop in premature infants weeks after birth. Complications like necrotizing enterocolitis or septicemia may trigger this white matter damage, necessitating ongoing neurological surveillance.
Area of Science:
- Neonatal neurology
- Pediatric neurology
- Developmental neuroscience
Background:
- Premature infants are susceptible to brain injury.
- Cystic periventricular leukomalacia (cPVL) is a common form of white matter damage in preterm neonates.
- Traditional understanding focuses on early-onset injury.
Purpose of the Study:
- To describe a late-onset form of cystic periventricular leukomalacia (cPVL) in premature infants.
- To determine the incidence of late-onset cPVL.
- To identify potential triggers for this delayed white matter damage.
Main Methods:
- Retrospective study of 1452 surviving infants born before 33 weeks gestation.
- Analysis of neurological assessments and intercurrent complications.
- Identification of cPVL cases appearing after the first 5 weeks of life.
Main Results:
- Ten cases of late-onset cPVL were identified.
- In 8 of these cases, an intercurrent event with systemic inflammation preceded cyst development.
- Common triggers included necrotizing enterocolitis (5 cases) and septicemia (2 cases).
Conclusions:
- Late-onset cPVL can occur in very preterm infants.
- Systemic inflammatory events, such as necrotizing enterocolitis and septicemia, may precipitate white matter damage.
- Repeated neurological surveillance until discharge is crucial, especially following complications.
Abstract:
The purposes of this study are (1) to describe a "late-onset" form of cystic periventricular leukomalacia eventually appearing in premature infants whose neurological assessments were normal in the first month of life; (2) to retrospectively evaluate its incidence among a large population of premature infants; (3) to suggest that a few unexpected complications of prematurity may trigger the development of white matter damage, even several weeks after birth. Retrospective study in a population of 1452 surviving infants after 5 days born before 33 weeks. We identified 10 cases of late-onset cystic periventricular leukomalacia appearing beyond the first 5 weeks of life. In 8 cases, an intercurrent event associated with a systemic inflammatory response preceded the appearance of cysts: necrotizing enterocolitis (n = 5), septicemia (n = 2 cases), strangulated inguinal hernia in one infant. Neurological surveillance should be repeated until discharge in very preterm infants, especially after the occurrence of an intercurrent complication coming along with a systemic inflammatory response.