PERIVENTRICULAR NECROS IS IN PRETERM INFANTS: SONOGRAPHIC OBSERVATIONS

Abstract

Periventricular cerebral white matter necrosis (PVN), common in preterm infants dying in the 1st week, is associated with motor abnormalities in survivors & is characterized by necrosis, vascular congestion & hemorrhage. Cavitation develops in the necrotic area. The clinical aspects of PVN are unknown since the diagnosis is done at autopsy. With ultrasound (US) we studied this lesion in 10 preterm infants <2000 gm finding 2 distinct phases. Initially, there are very echogenic zones adjacent to atria and anterior horns. Later, cystic lesions develop within these regions. Echogenic areas were found as early as 1 hr after birth & cysts were found on day 1 or between 4 & 23 days. PVN was associated with asphyxia, hypoxia, hypotension &/or apnea. Cysts were present in 2 infants without clinical problems. Postmortem examinations of the brains in 4 infants found congestion, petechial hemorrhages, perivascular bleeding &/or necrosis in the echogenic zones. Computerized tomograph (CT) showed periventricular areas of low attenuation & did not display cysts, congestion or small hemorrhages. Two infants with large cysts in US had "normal" CT studies by the 5th month. By the 2nd yr these 2 infants had spastic quadriparesis. Four infants are <6 mos. old & are being followed. Two have abnormal neurologic exams. PVN can be diagnosed & followed with US. The presence of cysts on day one indicate that in some patients PVN may develop in utero.