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Obstetric risk factors for periventricular leukomalacia among preterm infants
A Spinillo1, E Capuzzo, M Stronati
1Department of Obstetrics and Gynaecology, IRCCS Policlinico San Matteo, Pavia, Italy.
Insights
Maternal infections, birth acidosis, and meconium-stained amniotic fluid are key risk factors for periventricular leukomalacia in preterm infants. Long-term ritodrine use may increase the risk of transient echodense lesions, impacting neonatal brain development.
Area of Science:
- Neonatal Neurology
- Perinatal Medicine
- Obstetrics
Background:
- Periventricular leukomalacia (PVL) is a significant cause of neurological impairment in preterm infants.
- Identifying obstetric antecedents is crucial for targeted prevention strategies.
- Understanding risk factors for both cystic and transient echodense lesions is essential for comprehensive neonatal care.
Purpose of the Study:
- To investigate the association between obstetric factors and the development of cystic PVL and transient echodense periventricular lesions.
- To identify specific risk factors contributing to different types of white matter injury in preterm neonates.
- To inform clinical practice and improve outcomes for high-risk preterm infants.
Main Methods:
- A cohort study involving 349 preterm singleton infants (25-33 weeks gestation) admitted to a Neonatal Intensive Care Unit.
- Cranial ultrasonography was used to screen for periventricular leukomalacia.
- Stepwise multiple logistic regression analysis compared obstetric factors between infants with and without PVL, adjusting for confounders.
Main Results:
- Prevalence of cystic PVL was 5.7% and transient echodense lesions was 14%.
- Risk factors for cystic PVL included first-trimester hemorrhage, maternal urinary tract infection, and neonatal acidosis at birth.
- Meconium-stained amniotic fluid and prolonged ritodrine tocolysis (>72 hours) were associated with echodense lesions.
Conclusions:
- Maternal infection, birth acidosis, and meconium-stained amniotic fluid are confirmed risk factors for PVL in preterm infants.
- Long-term ritodrine tocolysis appears to elevate the risk of transient echodense periventricular lesions.
- These findings highlight the importance of managing maternal infections and monitoring preterm infants with specific obstetric histories.
Objective:
To evaluate the obstetric antecedents of cystic periventricular leukomalacia and transient echodense periventricular lesions among preterm infants.
Design:
A cohort study of preterm singleton infants born between 25 and 33 weeks gestation.
Setting:
Pavia, Italy.
Population:
Three hundred and forty-nine infants admitted to a Division of Neonatal Intensive Care who were screened for periventricular leukomalacia.
Method:
The obstetric factors in infants with either cystic periventricular leukomalacia or transient echodense periventricular lesions were compared to those in infants with negative cranial ultrasonographic findings. Stepwise multiple logistic regression analysis was used to evaluate the association between risk factors and outcomes adjusting for confounders.
Results:
The prevalence of cystic periventricular leukomalacia and transient echodense lesions was 5.7% (20/349) and 14% (49/349), respectively. The main risk factors for cystic leukomalacia were first trimester haemorrhage (OR 4.49; 95% CI 1.63-12.39), maternal urinary tract infection on admission (OR 5.71; 95% CI 1.91-17.07), and neonatal acidosis (pH < 7.2) at birth (OR 5.97; 95% CI 1.93-18.52). Meconium-stained amniotic fluid (OR 3.95; 95% CI 1.42-10.98) and long term (> 72 hours) ritodrine tocolysis (OR 2.54; 95% CI 1.28-5.05) were associated with an increased risk of echodense lesions. The likelihood of overall leukomalacia (cystic plus echodense periventricular lesions) was increased among cases with meconium-stained amniotic fluid (OR 4.06; 95% CI 1.65-10.0), long-term ritodrine tocolysis (OR 2.56; 95% CI 1.38-4.72), maternal infection (OR 1.73; 95% CI 1.0-3.0), and acidosis at birth (OR 1.98; 95% CI 1.0-3.98).
Conclusions:
This study confirms that maternal infection, acidosis at birth, and meconium-stained amniotic fluid increase the risk of periventricular leukomalacia in preterm infants. Long-term ritodrine use seems to increase the risk for transient echodense lesions.