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Visual and neurological outcome of infants with periventricular leukomalacia
M S Scher1, V Dobson, N A Carpenter
1Department of Pediatrics, Magee-Womens Hospital, Pittsburgh, PA 15213.
Insights
Infants with periventricular leukomalacia (PVL) showed generally normal visual acuity and improving neurological status. Non-cavitary PVL outcomes were more favorable than cavitary PVL.
Area of Science:
- Neonatal neurology
- Pediatric ophthalmology
- Neurodevelopmental disorders
Background:
- Periventricular leukomalacia (PVL) is a common neonatal brain injury.
- PVL can impact visual and neurological development in infants.
- Understanding long-term outcomes is crucial for early intervention.
Purpose of the Study:
- To assess visual acuity, visual fields, and neurological status in infants with PVL.
- To compare outcomes between cavitary and non-cavitary PVL.
- To track developmental trajectories from 16 to 72 weeks post-confinement.
Main Methods:
- Longitudinal assessment of 10 infants diagnosed with PVL.
- Evaluations included visual acuity, visual fields, and neurological examinations.
- Electroencephalography (EEG) abnormalities were also monitored.
Main Results:
- Eight out of 10 infants had normal monocular visual acuity development.
- Visual fields were restricted in over half of infants at earlier time points, improving by 72 weeks.
- Most infants showed neurological abnormalities under one year, with four remaining affected beyond that age.
Conclusions:
- Infants with non-cavitary PVL demonstrated more favorable visual acuity and neurological outcomes compared to those with cavitary PVL.
- Early visual field restrictions and neurological abnormalities can improve over time.
- Severe PVL, particularly cavitary types, is associated with persistent abnormalities.
Abstract:
Visual acuity, visual fields and neurological status were assessed in 10 infants with periventricular leukomalacia (PVL), tested at 16, 36, 48 and 72 weeks from the expected date of confinement. Monocular acuity development was normal in eight of the 10 infants, but was below normal in one infant at eight months and in another at 18 months. Over half the infants tested at 16, 36 and 48 weeks had smaller visual fields than those of 95 per cent of healthy preterm infants tested at the same ages, but by 72 weeks only two of six infants tested had restricted visual fields. Nine of the 10 infants were neurologically abnormal at ages under one year, but only four remained so beyond one year. These results indicate more favourable outcomes for visual acuity and neurological status in infants with non-cavitary PVL than have been reported in infants with cavitary PVL. The most compromised infants were one with cavitary PVL and another with extensive non-cavitary PVL who had the longest-lasting EEG abnormalities of all 10 infants.