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Muscle power development in preterm infants with periventricular flaring or leukomalacia in relation to outcome at 18
Janny F Samsom1, Lilian T L Sie, Laila de Groot
1Department of Paediatrics, VU University Medical Centre, Amsterdam, The Netherlands. J.Samsom@VUMC.NL
Insights
Periventricular leukomalacia (PVL) impacts infant motor function, with severity correlating to shoulder and trunk muscle power deficits. Early assessment of muscle power can predict long-term neurological impairment in affected newborns.
Area of Science:
- Neonatal neurology
- Pediatric neurodevelopment
- Medical imaging in neonates
Background:
- Periventricular leukomalacia (PVL), diagnosed via neonatal brain ultrasound, is a significant concern for infant neurodevelopment.
- Understanding the long-term motor outcomes associated with PVL severity is crucial for early intervention.
Purpose of the Study:
- To assess the relationship between the severity of Periventricular Leukomalacia (PVL) and motor development in infants.
- To identify early neurological predictors of motor impairment at 18 months corrected age.
Main Methods:
- Neonatal brain ultrasounds diagnosed PVL in 44 infants (mean GA 31 weeks).
- Neurological examinations assessed muscle power and symmetry at 0, 3, and 6 months corrected age.
- Motor outcomes were graded at 18 months corrected age.
Main Results:
- Poor muscle power regulation, particularly in shoulders and trunk, was observed in infants with higher PVL grades (III/IV) at 3 and 6 months.
- At 18 months, 12 infants had severe impairment, including all with PVL grades II or IV.
- Combined shoulder and trunk muscle power at 3 months, and shoulder muscle power at 6 months, best predicted 18-month impairment.
Conclusions:
- Muscle power assessment in the neonatal period can predict long-term neurodevelopmental outcomes in infants with PVL.
- Early identification of muscle power deficits, especially in the shoulders and trunk, is vital for infants diagnosed with PVL.
- PVL severity significantly influences motor outcomes, highlighting the need for targeted follow-up and interventions.
Abstract:
Periventricular flaring (PVF) or periventricular leukomalacia (PVL) was diagnosed by brain ultrasound during the neonatal period in 44 infants (34 males, 10 females; mean gestational age 31 weeks 2 days, SD 2 weeks 1 day) admitted between 1995 and 1997. The infants were divided into three groups according to the severity of their condition. At 0, 3, and 6 months' corrected age an age-adequate neurological examination with special emphasis on the relation between active and passive muscle power was performed and symmetry between right and left sides was assessed. Results for the whole body, as well as for the shoulders, trunk, and legs were classified as optimal, suspect, or abnormal. Motor outcome at 18 months' corrected age was graded in the same way. An overall optimal muscle power regulation was found in one infant at 0, two at 3, and one at 6 months. Suspect outcome was found at all ages in the three groups. At 0 months muscle power regulation did not differ between the three groups. At 3 and 6 months overall poor muscle power, primarily caused by poor muscle power regulation in the shoulders and trunk, was found in infants with PVL grades III or IV. At 18 months' corrected age 24 infants showed no neurological impairment, eight infants had minor impairment, and 12 infants had severe impairment, including all 10 infants categorized as having PVL grades II or IV. The best predictors of impairment at 18 months were the combined results of muscle power in the shoulders and trunk at 3 months with those of the shoulders at 6 months.
