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Incidence, timing, and follow-up of periventricular leukomalacia
M C Goetz1, R J Gretebeck, K S Oh
1Medical College of Pennsylvania, Pittsburgh, USA.
Insights
Late ultrasound screening is crucial for very low birthweight infants, even with normal initial scans. This approach helps detect periventricular leukomalacia and associated developmental delays in high-risk newborns.
Area of Science:
- Neonatal neurology
- Pediatric imaging
- Developmental pediatrics
Background:
- Periventricular leukomalacia (PVL) is a significant cause of neurological impairment in preterm infants.
- Early detection of PVL is critical for timely intervention and management.
- Standard screening protocols may miss delayed onset of PVL.
Purpose of the Study:
- To evaluate the necessity of late ultrasound screening in very low birthweight (VLBW) infants.
- To determine the incidence and timing of PVL development in VLBW infants.
- To assess the neurodevelopmental outcomes associated with PVL.
Main Methods:
- Screening cranial ultrasounds were conducted on 115 VLBW infants within the first week of life.
- Infants were monitored for the development of PVL through serial ultrasounds.
- Developmental follow-up assessments were performed on a subset of the infants.
Main Results:
- 12% (14/115) of VLBW infants developed PVL.
- All infants who developed PVL weighed 1100g or less at birth.
- Cystic PVL developed between 17 and 104 days of age, with later onset in those with initially normal scans.
- Tone abnormalities and severe cognitive delays were observed in infants with PVL.
Conclusions:
- Late ultrasound screening is essential for VLBW infants, irrespective of initial scan results.
- Delayed-onset PVL can occur and is associated with significant neurodevelopmental deficits.
- Serial neuroimaging is vital for comprehensive assessment and management of VLBW infants.
Abstract:
Screening cranial ultrasounds were performed on 115 very low birthweight infants during the first week of life. Fourteen infants (12%) developed changes of periventricular leukomalacia. All 14 weighted 1100 g or less at birth. Eight infants' initial studies were normal, four had intraventricular hemorrhage, and two had periventricular echo densities. Cystic periventricular leukomalacia developed between 17 and 104 days of age and occurred later in those infants whose initial study was normal. There were tone abnormalities in 11 of the 12 infants who received developmental follow-up. Severe cognitive delays were common in the older infants. This study demonstrates the need for late ultrasound screening even in the presence of initial normal ultrasound examinations.