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Chest physiotherapy and porencephalic brain lesions in very preterm infants

D B Knight1, C J Bevan, J E Harding

  • 1National Women's Hospital, Auckland, New Zealand. davidk@adhb.govt.nz

Journal of Paediatrics and Child Health
|March 21, 2002
PubMed

Insights

Encephaloclastic porencephaly (ECPE) in preterm infants decreased as chest physiotherapy use also declined. However, the 1992-1994 ECPE cases suggest another factor, not just physiotherapy, caused the brain lesions.

Area of Science:

  • Neonatal neurology
  • Pediatric critical care
  • Neurodevelopmental disorders

Background:

  • Encephaloclastic porencephaly (ECPE) is a destructive brain lesion observed in extremely preterm infants.
  • Previous associations noted non-cephalic presentation, early hypotension, and chest physiotherapy frequency with ECPE.
  • National Women's Hospital has reported cases of ECPE in this vulnerable population.

Purpose of the Study:

  • To investigate the temporal relationship between ECPE and chest physiotherapy in very low-birth weight (VLBW) infants.
  • To understand the evolving patterns of ECPE and its potential triggers in a specific neonatal unit.

Main Methods:

  • Retrospective review of cerebral ultrasound, post-mortem reports, and clinical/physiotherapy records.
  • Inclusion criteria: VLBW infants admitted between 1985 and 1998.
  • Exclusion criteria: babies without late ultrasound scans where ECPE was unlikely.

Main Results:

  • ECPE was identified in 13 infants born between 1992-1994.
  • Chest physiotherapy treatments per infant decreased significantly from 1989 onwards, with treatment initiation age increasing.
  • Physiotherapy use was completely withdrawn by 1995.

Conclusions:

  • ECPE emerged as a concern during a period of reduced chest physiotherapy.
  • The cluster of ECPE cases (1992-1994) coincided with decreased physiotherapy but likely stemmed from an unidentified factor.
  • Further research is needed to elucidate the etiology of ECPE in VLBW infants.
Abstract

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