Neonates born at term with periventricular haemorrhagic infarction: Risk factors and clinical presentation

This is a case series of neonates born near term presenting with periventricular haemorrhagic infarction (PVHI), determining possible risk factors, clinical presentation, magnetic resonance imaging (MRI), and amplitude-integrated electroencephalography (aEEG) characteristics, and neurodevelopmental outcomes. Twenty term-born neonates, diagnosed with PVHI less than 4 weeks after birth were included. Clinical characteristics and presenting symptoms were gathered from electronic patient records. PVHI anatomical venous subtype involvement was classified on MRI. aEEG recordings were scored on background activity, sleep-wake cycling, and seizures. Neurodevelopmental outcome was assessed at median age of 5 years 10 months. The majority of neonates (n = 19) presented with seizures around the second day after birth. Methylenetetrahydrofolate reductase mutations were present in 10 out of 11. The caudate vein territory was most commonly involved (n = 11). aEEG patterns in the first 24 hours after symptoms showed more discontinuous background and less sleep-wake cycling in the ipsilesional hemispheres. PVHI in term-born neonates most often presents with seizures. Neonatal complications during pregnancy and delivery and prothrombotic genetic mutations were slightly more common in this group.