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White matter damage and intraventricular hemorrhage in very preterm infants: the EPIPAGE study
Béatrice Larroque1, S Marret, Pierre-Yves Ancel
1INSERM U149 Research Unit on Perinatal Health and Women's Health, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France. larroque@vjf.inserm.fr
Insights
White matter damage (WMD) is common in very preterm infants and strongly linked to gestational age. Cystic periventricular leukomalacia (PVL) incidence was similar in infants with and without intrauterine growth restriction.
Area of Science:
- Neonatal neurology
- Pediatric imaging
- Perinatal medicine
Background:
- Very preterm infants face significant risks of brain injury.
- Cranial ultrasound is crucial for detecting abnormalities in this population.
Purpose of the Study:
- To determine the prevalence of cranial ultrasound abnormalities in very preterm infants.
- To assess the influence of gestational age, plurality, intrauterine growth restriction, and mortality on these abnormalities.
Main Methods:
- Prospective, population-based cohort study.
- Included 2667 infants born between 22-32 weeks gestation.
- Cranial ultrasound scans were analyzed.
Main Results:
- White matter damage (WMD) occurred in 21% of infants.
- Risk of WMD increased with lower gestational age.
- Cystic periventricular leukomalacia (PVL) was diagnosed at a later age in more premature infants.
Conclusions:
- WMD is highly prevalent in very preterm infants, primarily associated with gestational age.
- Intrauterine growth restriction did not alter the prevalence of cystic PVL.
Objective:
To evaluate the prevalence of cranial ultrasound abnormalities in very preterm infants as a function of gestational age, plurality, intrauterine growth restriction, and death before discharge.
Study Design:
A prospective, population-based cohort of 2667 infants born between 22 and 32 weeks of gestation in 1997 in nine regions of France, transferred to a neonatal intensive care unit, for whom at least one cranial ultrasound scan was available.
Results:
The frequencies of white matter damage (WMD), major WMD, cystic periventricular leukomalacia (PVL), periventricular parenchymal hemorrhagic involvement, and intraventricular hemorrhage with ventricular dilatation were 21%, 8%, 5%, 3%, and 3%, respectively. The risk of WMD increased with decreasing gestational age. Mean age at diagnosis of cystic PVL was older for the most premature infants. Intraventricular hemorrhage with ventricular dilatation was associated with a higher risk of cystic PVL. Intrauterine growth restriction was not associated with a lower prevalence of cystic PVL.
Conclusion:
The frequency of WMD is high in very preterm babies and is strongly related to gestational age. The incidence of cystic PVL did not differ between babies with intrauterine growth restriction and babies who were appropriate for gestational age.
