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Interaction between perinatal brain damage and processes of normal brain development. Ultrasonographic and
Insights
High-risk neonates with brain injuries like periventricular-intraventricular hemorrhage (PVH) and periventricular leukomalacia (PVL) show variable outcomes. Prognosis depends on lesion extent, location, and brain maturation, highlighting the need for tailored assessments.
Area of Science:
- Neonatal Neurology
- Pediatric Neuroimaging
- Developmental Neuroscience
Background:
- High-risk neonates are susceptible to various forms of cerebral damage.
- Understanding the impact of brain lesions on neurodevelopment is crucial for early intervention.
Purpose of the Study:
- To systematically assess ultrasonographic findings and neurodevelopmental outcomes in high-risk neonates.
- To correlate specific brain lesions with prognosis in preterm and term infants.
Main Methods:
- Systematic ultrasonographic examination of high-risk neonates.
- Prospective neurodevelopmental assessment of infants in two groups: preterm (≤34 weeks gestation) and term (>34 weeks gestation).
Main Results:
- In preterm infants (Group A), periventricular-intraventricular hemorrhage (PVH) and periventricular leukomalacia (PVL) were common, with poorer prognosis linked to diffuse PVL.
- In term infants (Group B), diverse lesions including malformations, infections, and hypoxic-ischemic damage were observed, all associated with poor outcomes.
- Hypoxic-ischemic damage targets varied by maturation: germinal layer/periventricular white matter in immature infants, cortex/basal ganglia in mature infants.
Conclusions:
- Cerebral damage in neonates is influenced by brain maturation, insult type/timing, and lesion extent/location.
- Ultrasonography is vital for identifying lesions and predicting neurodevelopmental outcomes in high-risk neonates.
- Prognosis is significantly poorer for extensive PVL, malformations, infections, and hypoxic-ischemic damage.
Abstract:
A systematic ultrasonographic study and a prospective neurodevelopmental assessment were carried out in a population of high-risk neonates. In group A (82 preterm infants of 34 weeks gestation or less), periventricular-intraventricular hemorrhage (PVH) and periventricular leukomalacia (PVL) were the commonest lesions. The association of PVH, PVL and ventricular dilatation had a variable outcome and the prognosis was found to be poorer in the presence of diffuse or extensive PVL. In group B (115 neonates of more than 34 weeks gestation), miscellaneous ultrasound changes were observed (malformations, infections, hemorrhages and hypoxic-ischemic lesions). Malformations, hypoxic-ischemic damage and prenatal infections had a gloomy prognosis. The main targets of hypoxic-ischemic damage in the immature infant were the germinal layer and the periventricular white matter, while in the mature infant the cortex and basal ganglia were more vulnerable. A relation between the localization and the size of the lesion could be established. In conclusion, basic forms of cerebral damage should therefore be understood in terms of brain maturation, type and timing of the insult, extent and localization of the lesion.