On the relationship between germinal layer haemorrhage and telencephalic leucoencephalopathy in the preterm infant

The brains of 54 deceased preterm infants were retrospectively studied for signs of germinal layer haemorrhage (GLH) and telencephalic leucoencephalopathy (TLE). On the basis of presence or absence of iron laden macrophages (siderophages) the cases with germinal layer haemorrhage were sub-classified as either "old" or "fresh" haemorrhage. Cases without GLH (non-GLH) were used as a control group. The distribution of ages at death in the non-GLH group was such that comparison to both fresh GLH cases and old GLH cases was possible. The distribution of pregnancy duration in GLH and non-GLH cases was similar. Statistical evaluation showed that old GLH cases were more often associated with TLE as either fresh GLH or non-GLH cases. By comparison of the three groups it is shown that differences in age at death do not explain the higher incidence of TLE in the old GLH group compared to the fresh GLH group. Hydrocephalus was found in the majority of old GLH cases. From a neuropathological view this complication is unlikely to account for the excess of TLE-lesions in that group. A logic explanation of the findings in this study is that the association between GLH and TLE is due to a common origin: asphyxia. The relatively low incidence of TLE in fresh GLH cases may be due to early death precluding detection of TLE. It is advocated that studies on GLH or TLE be comprehensively based on both phenomena to further the understanding on how they contribute to death or handicap.