Leucomalacia y ecogenicidad periventricular en prematuros de muy bajo peso al nacer

Abstract

Cystic periventricular leukomalacia (c-PVL) and persistent periventricular echogenicity (PPVE) are white matter injuries of multifactorial etiology, high incidence in premature infants and with harmful effect in neurodevelopment.To determine PPVE and c-PVL incidence, and to assess potential predictors.Cohort of 164 very low birth weight premature infants (< 1,500 g and with gestational age equal or below 32 weeks), admitted to the Neonatal Care Unit of Hospital Clinico Regional de Valdivia, Chile. Cerebral ultrasound within the first week, at day 15 and day 30 of life was performed, and diagnosis of the lesions was made according Volpe's classification. The association of PPVE and c-PVL with several perinatal factors was evaluated by univariate risk estimation -relative risk (RR), and 95% confidence interval (95% CI)-, and then, multivariate analysis through multiple logistic regression -adjusted odds ratio (OR)--was carried out.The incidence of PPVE and c-PVL was 13.4 and 23.8%, respectively. 66.7% of c-PVL cases were observed in infants lower than 28 weeks (RR = 4.83; 95% CI = 2.72-8.58). The risk of c-PVL was lower with gestational age for each additional week (OR = 0.5; 95% CI = 0.38-0.65) and maternal hypertension (OR = 0.27; 95% CI = 0.08-0.87). A significant decrease of PPVE risk was found with better Apgar score after 1 minute and male sex. No association was found with either chorioamnionitis, antenatal corticosteroids nor other perinatal factors.This study confirms high incidence of white matter lesions, being gestational age a strong predictor of c-PVL. Studies are needed to clarify maternal hypertension effect on c-PVL development.