Emerging concepts in periventricular white matter injury

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Updated: Aug 11, 2026

Mouse Models of Periventricular Leukomalacia
06:24

Mouse Models of Periventricular Leukomalacia

Published on: May 18, 2010

Stephen A Back1, Scott A Rivkees

  • 1Department of Pediatrics, Oregon Health Science University, Portland, OR, USA.

Seminars in Perinatology
|February 8, 2005
PubMed

Insights

Periventricular white matter injury (PWMI) is the leading cause of brain damage in preterm infants, often leading to lifelong neurological deficits. Understanding PWMI pathogenesis is key to developing new preventative strategies for premature infants.

Area of Science:

  • Neonatal neurology
  • Neuroscience
  • Developmental pediatrics

Background:

  • Premature birth affects approximately 10% of newborns, with over 10% experiencing neurological injuries.
  • Periventricular white matter injury (PWMI) is now the most common cause of brain injury in preterm infants, surpassing intraventricular hemorrhage.
  • Chronic PWMI encompasses both focal cystic lesions (periventricular leukomalacia; PVL) and diffuse myelination disturbances, with diffuse injury becoming more prevalent.

Purpose of the Study:

  • To review the current understanding of the pathogenesis of periventricular white matter injury (PWMI) in preterm infants.
  • To highlight the shift in predominant lesion type from focal cystic lesions to diffuse white matter injury.
  • To identify key factors and mediators implicated in the development of PWMI.

Main Methods:

  • Review of recent neuroimaging studies and existing literature on preterm infant brain injury.
  • Analysis of factors predisposing to periventricular white matter injury (PWMI), including prematurity, hypoxia, ischemia, and inflammation.
  • Examination of proposed pathogenic mechanisms, such as oligodendrocyte progenitor injury, microglial activation, and axonal damage.

Main Results:

  • The incidence of periventricular leukomalacia (PVL) is declining, while diffuse cerebral white matter injury is emerging as the predominant lesion.
  • Factors like prematurity, hypoxia, ischemia, and inflammation contribute to PWMI.
  • Oligodendrocyte progenitor injury, microglial activation, axonal damage, and chemical mediators (ROS, RNS, glutamate, cytokines, adenosine) are implicated in PWMI pathogenesis.

Conclusions:

  • Periventricular white matter injury (PWMI) is a significant concern in preterm infants, with diffuse injury patterns becoming more common.
  • Understanding the complex interplay of factors and mediators involved in PWMI pathogenesis is crucial.
  • Further research into PWMI pathogenesis is expected to yield novel strategies for preventing brain injury in premature infants.

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