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Possible etiological factors in extensive periventricular leukomalacia of preterm infants
R S Ikonen1, E J Kuusinen, M O Janas
1Department of Paediatrics, Tampere University Central Hospital, Finland.
Insights
Extensive periventricular leukomalacia (PVL) in preterm infants may be linked to higher bilirubin levels and blood pH. This suggests bilirubin toxicity could contribute to brain damage in addition to ischemia.
Area of Science:
- Neonatal neurology
- Perinatal medicine
- Pediatric neuroimaging
Background:
- Periventricular leukomalacia (PVL) is a significant cause of neurological impairment in preterm infants.
- Routine ultrasound screening is crucial for early detection of brain abnormalities in neonates.
- Understanding risk factors for PVL is essential for developing preventative strategies.
Purpose of the Study:
- To investigate potential perinatal factors associated with extensive periventricular leukomalacia (PVL) in preterm infants.
- To compare the perinatal course and later development of infants with PVL to a control group.
Main Methods:
- Retrospective case-control study comparing five preterm infants with extensive PVL (gestational age 31-32 weeks) to 12 matched controls.
- Analysis of routine ultrasound findings, perinatal clinical data, and serum bilirubin levels.
- Comparison of blood pH values within the first 72 hours of life.
Main Results:
- Infants diagnosed with extensive PVL were more frequently delivered vaginally (p = 0.0034).
- PVL infants exhibited significantly higher mean peak serum total bilirubin levels (p = 0.0054).
- Higher mean blood pH values during the first 72 hours were observed in PVL infants (p = 0.0311).
Conclusions:
- Results suggest that factors beyond periventricular ischemia may contribute to extensive PVL.
- Elevated bilirubin levels and altered blood pH are potential contributing factors in PVL development.
- Bilirubin toxicity is hypothesized to play a role in the severe brain damage associated with extensive PVL.
Abstract:
During a twelve-month period five cases of extensive periventricular leukomalacia (PVL) in preterm infants with a gestational age of 31-32 weeks were diagnosed by routine ultrasound screening of preterm infants. The perinatal courses and later development of these infants were compared with 12 other infants with a comparable gestational age born during the same time period. PVL babies were delivered more often by the vaginal route (p = 0.0034), and their mean highest serum total bilirubin value was significantly higher (p = 0.0054) than that of the control infants. The mean value of the highest blood pH during the first 72 hours of life was also significantly higher (p = 0.0311) in PVL babies than in control babies. On the basis of these results we speculate that in addition to ischaemia in the periventricular area, bilirubin toxicity may play an additional role in the severe damage seen in extensive periventricular leukomalacia.