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Neurodevelopmental outcome at 5-7 years in preterm infants with periventricular leukomalacia
1Department of Child Neuropsychiatry, IRCCS C Mondino, University of Pavia, Italy.
Insights
Periventricular leukomalacia (PVL) in infants can predict long-term neurodevelopmental outcomes. Larger or numerous PVL cysts correlate with higher risks of cerebral palsy (CP) and cognitive issues.
Area of Science:
- Neurology
- Pediatrics
- Developmental Neuroscience
Background:
- Periventricular leukomalacia (PVL) is a common form of brain injury in preterm infants.
- Understanding the long-term neurodevelopmental consequences of PVL is crucial for early intervention.
Purpose of the Study:
- To evaluate the 5-7 year neurodevelopmental outcomes of children with periventricular leukomalacia (PVL).
- To determine the relationship between PVL characteristics (type, size, location) and clinical outcomes, including cerebral palsy (CP) and cognitive function.
Main Methods:
- Retrospective analysis of 37 subjects with diagnosed PVL.
- Classification of subjects into three groups based on PVL type and clinical presentation.
- Assessment of neurodevelopmental outcomes using standardized measures, including McCarthy's Scales of Children's Abilities.
Main Results:
- All 14 subjects with cystic PVL measuring ≥ 5 mm-1 cm developed cerebral palsy (CP).
- Of 11 subjects with cystic PVL < 5 mm, only 2 developed CP; one had significant cognitive impairment (GII < 70).
- Subjects with "prolonged flare" PVL (n=12) showed varying outcomes, including CP (6), mild neurological signs (4), and normal development (2).
- Prognosis was linked to the site and number of PVL cysts.
- Cognitive profiles often exhibited disharmony, with notable discrepancies in verbal, performance, and motor scores.
Conclusions:
- PVL is a significant predictor of both short-term and long-term neurodevelopmental outcomes in children.
- The size, location, and number of PVL cysts are critical factors influencing the severity of neurological and cognitive deficits.
- PVL assessment serves as a valuable diagnostic tool for anticipating and managing neurodevelopmental challenges.
Abstract:
We describe outcome at 5-7 years of 37 subjects with periventricular leukomalacia (PVL). Children were divided into 3 groups based on PVL type and clinical outcome. Subjects with cystic PVL > or = 5 mm-1 cm or more (n = 14) all developed CP. CP was found in only 2 subjects out of 11 with cystic PVL < 5 mm. One had GII < 70 according to McCarthy's Scales of Children's abilities. Mild neurological signs were present in 7 and 1 child was normal. Subjects with so-called "prolonged flare" (n = 12) included 6 CP cases, 4 with mild neurological signs and 2 normal subjects. Prognosis was related to site and number of cysts. Cognitive profiles tended to be disharmonic, with discrepancies between verbal, performance and motor scores. We conclude that PVL represents an important diagnostic tool in both short and long-term neurodevelopmental outcome.