Risk Factors for Cystic Periventricular Leukomalacia in Very-Low-Birth-Weight Infants † 1232

Abstract

Cystic periventricular leukomalacia (PVL) occurs most commonly in very-low-birth-weight (VLBW, <1500 gm) infants and is associated with poor developmental outcome. Ischemia has been implicated in the pathogenesis of PVL and recently intrapartum magnesium sulfate (MAG) treatment has been suggested to be neuroprotective; however, clinically relevant risk factors and preventive measures for PVL in VLBW infants remain unclear. We performed a retrospective, matched case-control study of the predictors of PVL in all infants <1500 gm BW from 6/90 to 12/95, during which early and late sonographic screening was routine. We studied anteparum, intrapartum, and postnatal factors, concentrating on vascular, respiratory, and infectious factors, and on intrapartum MAG exposure. We identified 1417 VLBW infants and 54 cases of cystic PVL (inc. 3.8%) and matched 54 controls with normal sonograms (latest at least 30 days) for ±150 gm BW and date of birth. Controls and cases were similar in mean BW (978±234 vs 945±250gm) and gestational age (28±2 wks). PVL cases were more likely to be outborn (37% vs 19%), to have a rapid(≤3 hrs) period from rupture of membranes (ROM) to birth (62% vs 41%), to have a patent ductus arteriousus (60% vs 37%), and to have a higher max PaCO2 in the first 72 hrs (55±16 vs 48±16) and were less likely to have pre-eclampsia (4%vs 15%) (all P≤0.05). The proportions of any intrapartum MAG, tocolytic MAG, steroid use, chorioamnionitis, SGA, RDS, and indomethacin use were similar. When controlled for indomethacin use, MAG use, PaCO2, and delivery location, a logistic regression model determined that predictors for PVL were as in Table. We conclude that PDA and rapid labor course are risk factors for PVL and that pre-eclampsia is more important than MAG use in reducing brain injury.