Abstract
Objective. To identify the risk factors for cystic periventricular leukomalacia (cPVL) and their implications for deciding between immediate delivery and conservative management of preterm prelabor rupture of the membranes (pPROM). Methods. The following risk factors were compared between cPVL infants and 6440 controls: chorioamnionitis, sex, gestational age (GA), birth weight, pPROM, and pPROM-delivery interval. Factor impact on cPVL risk and clinical decision-making was determined by multivariate logistic regression. Results. Overall cPVL prevalence (n = 32) was 0.99/1000 births. All cPVL infants but one were born <34 weeks of gestation and were <2500 g; 56% had histological chorioamnionitis versus 1.1% of controls (OR 35.9; 95%-CI 12.6–102.7). Because chorioamnionitis is a postnatal diagnosis, logistic regression was performed with prenatally available factors: pPROM-delivery interval >48 hours (OR 9.0; 95%-CI 4.1–20.0), male gender (OR 3.2; 95%-CI 1.4–7.3). GA was not a risk factor if birth weight was included. Risk decreased with increasing fetal weight despite a prolonged pPROM-delivery interval. Conclusion. pPROM-delivery interval is the single most important prenatally available risk factor for the development of cPVL. Immediate delivery favors babies with chorioamnionitis but disfavors those with non infectious pPROM. In the absence of clinical chorioamnionitis fetal weight gain may offset the inflammatory risk of cPVL caused by a prolonged pPROM-delivery interval.
Highlights
Cerebral palsy includes a group of nonprogressive movement disorders due to brain lesions or abnormalities in early development [1]
The following risk factors were compared between cystic periventricular leukomalacia (cPVL) infants and 6440 controls: chorioamnionitis, sex, gestational age (GA), birth weight, prelabor rupture of the membranes (pPROM), and pPROM-delivery interval
Cranial ultrasound was obtained in infants with gestational age below 32 0/7 weeks or birth weight below 1500 g at days 1, 3, and 7 of life and repeated weekly until hospital discharge. cPVL was defined according to de Vries et al [23]
Summary
Cerebral palsy includes a group of nonprogressive movement disorders due to brain lesions or abnormalities in early development [1]. Chorioamnionitis is quite common and often subclinical: fever and inflammatory marker elevation are rare in the early stages, making diagnosis difficult. Against this background the optimal management of pPROM remains unknown. Zurich University Hospital has Journal of Pregnancy hitherto favored conservative management, delaying delivery until clinically mandatory, on the grounds that the higher mortality and morbidity of newborns at lower gestational age are proven whereas the effect of increasing cPVL risk by prolonging pregnancy remains unknown. The more limited objectives of the present study were to identify the risk factors for PVL in the conservative pPROM management setting and determine whether prolonging gestation outweighs the risk of cPVL due to chorioamnionitis
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