Neurological Outcome In Preterm Infants Research Articles

Prophylactic Low-Dose Paracetamol Administration for Ductal Closure and Microstructural Brain Development in Preterm Infants

Introduction: Prophylactic low-dose paracetamol administration is used to induce closure of the ductus arteriosus. Effects on the neurological outcome in preterm infants remain unknown. We compared microstructural brain development in very preterm infants with and without exposure to prophylactic paracetamol by using MR-based diffusion tensor imaging. Materials and Methods: Infants aged <32 gestational weeks born between October 2014 and December 2018 received prophylactic paracetamol (10 mg/kg intravenously every 8 h until echocardiography after at least 72 h) and form the paracetamol group; infants born between February 2011 and September 2014 form the control group. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) at term-equivalent age were measured in 14 defined cerebral regions and compared between the groups. Results: Included in the study were 340 infants, of whom 217 received prophylactic paracetamol, and 123 formed the control group. The paracetamol group showed significantly higher FA values and lower ADC values in the splenium of the corpus callosum, as well as higher FA values in the pons bilaterally, the left middle cerebellar peduncle, the right occipital white matter, and the right posterior limb of the internal capsule (p ≤ 0.02). Conclusion: The perceived safety of prenatal paracetamol exposure has been questioned in recent years. We found no impairment on microstructural maturation processes in the brain of preterm infants at term-equivalent age following early paracetamol administration. The clinical relevance of these imaging findings has to be determined in long-term follow-up studies on neurodevelopmental outcome.

The diagnostic value of cerebrospinal fluid protein in the assessment of neurological outcome in preterm infants with sepsis

Objective To investigate the diagnostic value of cerebrospinal fluid protein in the assessment of neurological outcome in preterm infants with sepsis. Methods A total of 80 preterm infants with sepsis were enrolled in the department of neonatology of Shanghai Children′s Hospital from June 2014 to June 2016.The lumbar puncture was completed within 24 hours after diagnosis of sepsis, and the results of cerebrospinal fluid protein were obtained.The prognosis of neurological development was assessed according to Gesell Developmental Quotient (DQ) at 6 months of adjusted gestational age.DQ> 85 was used as an indicator of good prognosis group.DQ≤85 was assigned to the poor prognosis group.The differences in protein content of cerebrospinal fluid between these two groups were retrospectively analyzed.The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of cerebrospinal fluid in evaluating the prognosis of preterm infants with sepsis. Results Cerebrospinal fluid protein content of poor prognosis group was higher than those in good prognosis group[(2 005.56±582.85)mg/L vs.(1 367.92±362.29)mg/L, t=-6.019, P<0.01]. The area under the ROC curve was 0.819(95%CI 0.711-0.927, P<0.05). The optimal threshold of cerebrospinal fluid protein was 1 560 mg/L with specificity of 75.5% and sensitivity of 81.5%. Conclusion Cerebrospinal fluid protein content has certain diagnostic value on the assessment of sepsis premature neurological prognosis. Key words: Sepsis; Preterm infants; Cerebrospinal fluid protein; Gesell Developmental Schedules; Neurodevelopment outcome

In Preterm Infants, Length Growth below Expected Growth during Hospital Stay Predicts Poor Neurodevelopment at 2 Years

Background: In preterm infants, neonatal weight growth is associated with neurodevelopmental outcome but is a poor indicator of growth quality. Objective: The aim of this work was to measure the relationship between neonatal length growth and the 2-year neurological outcome in preterm infants. Methods: A total of 2,403 infants enrolled in the LIFT cohort with gestational age less than 34 weeks were studied. Neonatal observed length growth (OLG) was calculated as the change in length Z-score between birth and discharge. Expected length growth (ELG) was estimated based on gestational age, birth weight Z-score, birth length Z-score, gender, and observed neonatal weight growth. The difference between OLG and ELG (∆_OLG-ELG) was calculated as OLG – ELG, and infants were ranked into 3 classes depending on their ∆_OLG-ELG (≤–0.5, –0.49 to 0.49, ≥0.50 Z-score). We explored the relationship between ∆_OLG-ELG and 2-year neurodevelopmental outcome (n = 2,036), and, in a subgroup (n = 85), between ∆_OLG-ELG and body composition at discharge. Results: ELG was strongly predicted from the above-mentioned parameters (R² = 0.73, p = 0.001). OLG correlated closely with gestational age (p = 0.001) but ∆_OLG-ELG did not (p = 1.0). OLG was not associated with a 2-year nonoptimal outcome after adjustment for gestational age, but ∆_OLG-ELG ≤–0.5 was; the crude and adjusted odds ratios were 1.63 and 1.56, respectively. ∆_OLG-ELG correlated negatively with fat mass (R² = 0.29, p = 0.006) before and after adjustment for gestational age. Conclusion: ∆_OLG-ELG is a marker of neonatal growth that does not depend on gestational age, and may reflect quality of growth. A ∆_OLG-ELG ≤–0.5 Z-score is associated with a higher risk for 2-year nonoptimal neurodevelopmental outcome.

Progress in clinical application of caffeine in neonates

Caffeine is a methylxanthine alkaloid compound, which is not only effective, but also safe and needn′t monitor the plasma concentration for the prevention and treatment of apnea in preterm infants, compared with theophylline.In recent years, it has been reported that caffeine is beneficial to improve weaning extubation success rate, reduce the incidence of bronchopulmonary dysplasia in preterm infants, reduce the risk of surgical closure of patent ductus arteriosus, and improve the long-term neurological outcome in preterm infants. Key words: Caffeine; Apnea; Newborn

High protein intake in human/maternal milk fortification for ≤1250 gr infants: intrahospital growth and neurodevelopmental outcome at two years.

Background and aim of the study:Extrauterine growth restriction and failure to thrive remain a major problem in Extremely Low Birth Weight infants. Nutritional support in preterm babies has the objective to improve the achieve rate of growth similar to those of the fetus in utero at the equivalent gestational age. The aim of the study was to evaluate feeding tolerance, intrahospital growth, neurological outcome and anthropometric data until 24 months of corrected age (mca) from different protein intake assumed by preterm babies <1250 g during their stay in NICU.Methods:The study evaluates auxological/neurodevelopmental outcomes until 24 months of corrected age (mca) in preterm infants with different protein intake (control group-CG: 3,5g Kg–1 perday; intervention group-PSG: 4,8g Kg–1 per day).Results:PSG group showed a significant higher length growth at 9 mca (p 0,04) and hearing/language score of Griffiths Mental Development Score (GMDS) at 12 (p 0,03) and 18 mca (p<0,05) comparing with CG. PSG-ELBW preterms showed an higher intrahospital head circumference (p 0,02) and length growth rate (p 0,04), greater Performance (p 0,04) and Hearing/Language (p 0,03) scores of GMDS at 3 and 12 mca. PSG-SGA preterms showed significantly higher scores in GMDS scores at 18 and 24 mca except for the locomotor domain.Conclusions:Supplemental enteral proteins lead to benefits of reduced postnatal growth restriction and better neurological outcome in preterm infants <1000 g and in those SGA <1250 g. (www.actabiomedica.it)

Assessment of general movements and heart rate variability in prediction of neurodevelopmental outcome in preterm infants

BackgroundAdverse neurologic outcome in preterm infants could be associated with abnormal heart rate (HR) characteristics as well as with abnormal general movements (GMs) in the 1st month of life. AimsTo demonstrate to what extent GMs assessment can predict neurological outcome in preterm infants in our clinical setting; and to assess the clinical usefulness of time-domain indices of heart rate variability (HRV) in improving predictive value of poor repertoire (PR) GMs in writhing period. Study designQualitative assessment of GMs at 1 and 3 months corrected age; 24h electrocardiography (ECG) recordings and analyzing HRV at 1 month corrected age. SubjectsSeventy nine premature infants at risk of neurodevelopmental impairments were included prospectively. Outcome measuresNeurodevelopmental outcome was assessed at the age of 2 years corrected. Children were classified as having normal neurodevelopmental status, minor neurologic dysfunction (MND), or cerebral palsy (CP). ResultsWe found that GMs in writhing period (1 month corrected age) predicted CP at 2 years with sensitivity of 100%, and specificity of 72.1%. Our results demonstrated the excellent predictive value of cramped synchronized (CS) GMs, but not of PR pattern. Analyzing separately a group of infants with PR GMs we found significantly lower values of HRV parameters in infants who later developed CP or MND vs. infants with PR GMs who had normal outcome. ConclusionsThe quality of GMs was predictive for neurodevelopmental outcome at 2 years. Prediction of PR GMs was significantly enhanced with analyzing HRV parameters.

Low levels of mannose-binding lectin at admission increase the risk of adverse neurological outcome in preterm infants: a 1-year follow-up study

Objective: The aim of this study was to explore the association between serum levels of mannose-binding lectin (MBL) at admission and neurodevelopmental outcomes in a group of Chinese preterm infants, observed prospectively, until 1-year of corrected age (CA).Methods: All preterm infants used in this study were received from the neonatal intensive care unit (NICU) of our Hospital between 1 January 2012 and 31 August 2013. Serum levels of MBL and clinical data were obtained at the time of admission. The influence of MBL levels on neurological outcome was assessed by logistic regression analysis. Clinical follow-up was performed at 1 year.Results: The study cohort consisted of 175 neonates at baseline and 105 finished the 1-year follow-up. The mean serum MBL levels at the time of admission were significantly lower in children with adverse neurological outcomes as compared with children with no adverse [0.53 (SD = 0.09) μg/ml versus 0.80 (SD = 0.17) μg/ml, respectively; t = 8.342, p < 0.0001]. In multivariate analysis, there was an increased risk of adverse neurological outcomes associated with MBL ≤ 0.68 μg/ml [odds ratios (OR) = 12.11, 95% confidence interval (CI): 2.31–30.32; p < 0.0001] after adjusting for possible factors.Conclusion: Preterm infants who had low levels of MBL at admission are exposed to an increased risk of adverse neurological outcomes.

Neurological examination combined with brain MRI or cranial US improves prediction of neurological outcome in preterm infants

BackgroundThe predictive value of the combination of neurological examination and brain magnetic resonance imaging (MRI) or cranial ultrasound (cUS) in preterm infants is not known. AimsTo study the prognostic value of the combination of neurological examination and brain MRI at term equivalent age (TEA) or serial neonatal cUS in very preterm infants for neurosensory outcome at 2years of corrected age. Study designA prospective follow-up study. SubjectsA total of 216 very preterm infants (birth weight 1132g [SD 331g]) born in Turku University Hospital, from 2001 to 2006, were included. Outcome measuresThe Dubowitz neurologic examination and brain MRI were done at TEA, and serial cUS examinations were performed until TEA. The Hammersmith Infant Neurological Examination (HINE) and neurosensory impairments (NSI) were assessed at 2years of corrected age. ResultsOf all infants, 163 (76%) had one or more deviant neurological items at TEA, and 32 (15%) had the HINE total score below the 10th percentile at 2years of corrected age. A total of 17 (8%) infants had NSI. Neurological examination at TEA improved the negative and positive predictive values of brain MRI for NSI from 99% to 100%, and from 28% to 35%, respectively, and the negative and positive predictive values of cUS from 97% to 100%, and from 61% to 79%, respectively. ConclusionsThe combination of the Dubowitz neurologic examination and the brain MRI at TEA or serial neonatal cUS provides a valuable clinical tool for predicting long-term neurosensory outcome in preterm infants.

MBL2 gene polymorphisms increase the risk of adverse neurological outcome in preterm infants: a preliminary prospective study.

As described in animal models, the lectin-complement pathway is central to the propagation of ischemia-reperfusion injuries in many tissues, including the brain. Similarly, it might affect the genesis of brain damage in preterm infants. MBL2 gene single-nucleotide polymorphisms (SNPs), regulating mannose-binding lectin (MBL) serum levels, could predict the risk of adverse neurological outcome in these infants. To evaluate the association between SNPs of the MBL2 gene and long-term neurological outcomes in preterm infants, 75 infants (gestational age (GA) ≤ 32 wk) were observed in a prospective longitudinal study and assessed by clinical and instrumental exams at 12 and 24 mo of corrected age (CA). They were genotyped for the promoter polymorphism -221 and for the exon-1 variant alleles (at codons 52, 54, and 57) of the MBL2 gene. The MBL2 exon-1 OO genotype was more frequent in children with an adverse neurological outcome (5/35; 7%) than in controls (0/40; 0%), P = 0.045. The risk of intraventricular hemorrhage in carriers of the genotype OO was marked, without reaching statistical significance (odds ratio: 8.67; 95% confidence interval: 0.87-86.06; P = 0.07). Preterm infants who are carriers of MBL2 exon-1 OO genotype are exposed to an increased risk of adverse neurological outcomes.

Minocycline protects the immature white matter against hyperoxia

Poor neurological outcome in preterm infants is associated with periventricular white matter damage and hypomyelination, often caused by perinatal inflammation, hypoxia–ischemia, and hyperoxia. Minocycline has been demonstrated in animal models to protect the immature brain against inflammation and hypoxia–ischemia by microglial inhibition. Here we studied the effect of minocycline on white matter damage caused by hyperoxia.To mimic the 3- to 4-fold increase of oxygen tension caused by preterm birth, we have used the hyperoxia model in neonatal rats providing 24h exposure to 4-fold increased oxygen concentration (80% instead of 21% O2) from P6 to P7. We analyzed whether minocycline prevents activation of microglia and damage of oligodendroglial precursor cell development, and whether acute treatment of hyperoxia-exposed rats with minocycline improves long term white matter integrity.Minocycline administration during exposure to hyperoxia resulted in decreased apoptotic cell death and in improved proliferation and maturation of oligodendroglial precursor cells (OPC). Minocycline blocked changes in microglial morphology and IL-1β release induced by hyperoxia. In primary microglial cell cultures, minocycline inhibited cytokine release while in mono-cultures of OPCs, it improved survival and proliferation. Long term impairment of white matter diffusivity in MRI/DTI in P30 and P60 animals after neonatal hyperoxia was attenuated by minocycline.Minocycline protects white matter development against oxygen toxicity through direct protection of oligodendroglia and by microglial inhibition. This study moreover demonstrates long term benefits of minocycline on white matter integrity.

LONG TERM NEURODEVELOPMENTAL OUTCOME IN A COHORT OF PRETERM INFANTS BORN AT GESTATIONAL AGE

Advances in perinatal care have led to an increase in survival of preterm children but have also increased the risk of long-term sequelae, like neurodevelopmental impairment and behavioral or emotional disturbance. To investigate neurodevelopmental patterns of preterm infants born at S. Maria alle Scotte Hospital, Siena, Italy. 128 babies with gestational age (GA) ≤32 weeks were admitted in 2006-2008 to Siena Hospital; 105 infants survived and were followed until three years of age, corrected for prematurity. Neurodevelopmental follow up was performed using Bayley scale of Infant and Toddler Development IIIed that consisted of five scales: Cognitive (CS), Language (LS), Motor (MS), Social-Emotional (SES) and Adaptive Behavior Scale (ABS). Intraventricular haemorrhage (IVH) was associated with lower motor score (P<0,001). Babies with retinopathy of prematurity (ROP) showed a lower score in CS, LS, MS and SES Bayley’s items (respectively p≤0,01; p≤0,05; p≤0,01; p≤0,05). Multiple regression analysis indicated as predictors of neurological outcome: gestational age (GA) for poor cognitive (p=0,016), language (p=0,004) and social-emotional development (p<0,0001), IVH for poor motor (p<0,0001) and adaptive behavior development (p<0,0001), twinship for better language (p=0,001) and social-emotional development (p=0,003). Bronchopulmoanry dyspasia (BPD) and patent ductus arteriosus (PDA) had a negative effect on respectively cognitive development (p=0,049) and social-emotional development (p=0,023). ROP, BPD, IVH, PDA, and GA significantly contributes to poor neurological outcome in preterm infants. BPD and IVH are the best predictors being associated with the lowest scores at Bayley scales. Surprisingly, twinship appeared to be a protective factor.

LONG TERM NEURODEVELOPMENTAL OUTCOME IN A COHORT OF PRETERM INFANTS BORN AT GESTATIONAL AGE &lt;32 WEEKS

Advances in perinatal care have led to an increase in survival of preterm children but have also increased the risk of long-term sequelae, like neurodevelopmental impairment and behavioral or emotional disturbance. To investigate neurodevelopmental patterns of preterm infants born at S. Maria alle Scotte Hospital, Siena, Italy. 128 babies with gestational age (GA) ≤32 weeks were admitted in 2006-2008 to Siena Hospital; 105 infants survived and were followed until three years of age, corrected for prematurity. Neurodevelopmental follow up was performed using Bayley scale of Infant and Toddler Development IIIed that consisted of five scales: Cognitive (CS), Language (LS), Motor (MS), Social-Emotional (SES) and Adaptive Behavior Scale (ABS). Intraventricular haemorrhage (IVH) was associated with lower motor score (P&lt;0,001). Babies with retinopathy of prematurity (ROP) showed a lower score in CS, LS, MS and SES Bayley’s items (respectively p≤0,01; p≤0,05; p≤0,01; p≤0,05). Multiple regression analysis indicated as predictors of neurological outcome: gestational age (GA) for poor cognitive (p=0,016), language (p=0,004) and social-emotional development (p&lt;0,0001), IVH for poor motor (p&lt;0,0001) and adaptive behavior development (p&lt;0,0001), twinship for better language (p=0,001) and social-emotional development (p=0,003). Bronchopulmoanry dyspasia (BPD) and patent ductus arteriosus (PDA) had a negative effect on respectively cognitive development (p=0,049) and social-emotional development (p=0,023). ROP, BPD, IVH, PDA, and GA significantly contributes to poor neurological outcome in preterm infants. BPD and IVH are the best predictors being associated with the lowest scores at Bayley scales. Surprisingly, twinship appeared to be a protective factor.

Associations between Maternal and Infant Morbidities and sRAGE within the First Week of Life in Extremely Preterm Infants

BackgroundSoluble RAGE (sRAGE) has been associated with multiple inflammatory responses including maternal chorioamnionitis and preeclampsia. Analysis of umbilical cord blood levels have also indicated that sRAGE levels in the infant are affected by maternal inflammation. S100b is a ligand for RAGE and increases in circulating S100b levels are associated with poor neurological outcome in preterm infants. The objective of this study was to determine whether sRAGE or s100b levels in plasma samples from extremely preterm infants at the end of the first week of life were correlated with infant morbidities and whether sRAGE and s100b levels at this time point were still associated with maternal inflammation. MethodsPlasma samples were collected from 130 preterm infants (≤28 weeks) at days of life 5, 6, or 7. sRAGE and s100b levels were measured by ELISA and data were analyzed by Pearson’s correlation or Generalized Estimating Equations. ResultssRAGE was negatively correlated with development of sepsis (p=0.024), the FiO2 requirement of the infant at the time of sampling (p=0.030), as well as maternal preeclampsia (p=0.046), and positively correlated with maternal chorioamnionitis (p=0.006). s100b levels were positively associated with maternal chorioamnionitis (p=0.039). No correlations were observed with other infant morbidities. ConclusionThese data indicate that sRAGE could potentially be a biomarker of early severe inflammatory responses in the preterm infant. However, more studies are needed to confirm the present findings.

Lack of Fidgety Movements at 15 Weeks Post-Term Relates to Cerebral Palsy and Adverse Cognitive Outcome in Preterm Born Children at 10 Years of Age

Background and Aims: The General-Movement-Assessment (GMA) is a powerful predictor of later neurological outcome in preterm infants. We wanted to determine whether GMA status during the Fidgety period at 15 weeks post-term, in preterm children can predict motor and cognitive outcomes at age 10.Methods: A prospective follow-up study performed at the St.Olav's University Hospital, Trondheim, Norway. Thirty-four infants were included with mean gestational age 27.5weeks (SD 3.0w) and mean birth weight 1008g (SD 462g). The GMA was performed at mean15 weeks post term. Fidgety movements were classified as absent (F-) or present (normal (F+), no-continuous (F+/−), or abnormal (AF) fidgety). At age 10 the Wechsler Intelligence Scale for Children-III (WISC-III) was performed to assess IQ-status. Differences in group means were compared.Results: Six infants had F- and all of them developed CP at age 10. Two of three children with F+/− had CP. One child with F+ had CP.Cognitive results are shown in table 1.Table 1 Full size tableConclusions: Preterm born children without fidgety at 15 weeks post term had cerebral palsy and lower total- and verbal-IQ as well as working-memory deficits at age 10.

Motor repertoire and neurological outcome in preterm infants

Motor repertoire and neurological outcome in preterm infants

General movements as a predictive tool of the neurological outcome in very low and extremely low birth weight infants — A South African perspective

BackgroundAt a time of increasing demands on South African limited healthcare resources, there is a need for an assessment method that can reliably predict neurological deficits in high-risk infants at an early age. ObjectiveThe objective of the study is to determine whether the qualitative assessment of fidgety movements will predict the neurological outcome of very low birth weight and extremely low birth weight infants admitted to Tygerberg Children's Hospital (TCH), Cape Town, South Africa. MethodologyA prospective descriptive study was conducted using Prechtl's method of qualitative assessment of fidgety movements at three months corrected age (CA). The study sample consisted of 115 infants, with a birth weight of ≤1250g each. At 12months CA, the infants' final motor outcome was classified as normal, abnormal or suspect according to assessments undertaken in line with those of Amiel-Tison and Gosselin, the Peabody Developmental Motor Scale and the Alberta Infant Motor Scale (AIMS). ResultsA significant relationship was found (ρ<0.01) between fidgety movement outcome and the infants' final motor outcome at 12months corrected age, with a sensitivity of ≥71%, a specificity of ≥89%, a positive predictive value of ≥80%, and a negative predictive value of ≥96%. ConclusionsThe results of the study indicated that Prechtl's qualitative method of fidgety movement assessment, as used in a clinical setting, is a highly sensitive and specific predictor of neurological outcome in preterm infants, which might effectively be used at TCH.

Intrauterine inflammation and preterm delivery

Spontaneous preterm delivery, prematurity, and low birth weight due to prematurity account for a great part of neonatal morbidity and mortality. Specifically, chronic amniotic fluid inflammation may cause preterm labor, with the involvement of different mediators that produce diverse aspects of the inflammatory response. Although bacteria are considered to be the main trigger for intrauterine infection/inflammation, viral infections also appear to be involved. Recently, molecular genetic techniques have helped us better understand the underlying pathophysiologic processes. This is especially important because epidemiological and experimental studies indicate that intrauterine infection and inflammation constitute a risk factor for adverse neurological outcome in preterm infants. Chronic subclinical chorioamnionitis associated with preterm birth can also modify lung development. Although no current clinical strategy is aimed at adapting the maternofetal inflammatory response, immunomodulators may serve as a future intervention in preterm embryos.

Intracerebellar hemorrhage in premature infants: sonographic detection and outcome

Intracerebellar hemorrhage is a rarely confirmed diagnosis in preterm infants in comparison to peri-/intraventricular hemorrhage. This study evaluates the incidence of intracerebellar hemorrhage and neurological outcome in preterm infants. 260 infants with gestational age of 22-32 weeks were studied prospectively by cranial ultrasound. Neurodevelopmental outcome was examined in the first three years of life. 15 infants had intracranial hemorrhage grade II-IV (10 intraventricular, 6 intracerebellar hemorrhage). Neurodevelopmental follow-up showed that one infant with intracerebellar hemorrhage is severely handicapped, two have moderate and two mild impairments and one has no sequelae. Cerebellar hemorrhage is not rare if ultrasound examination is specifically focused on cerebellar lesions.

Early Assessment of Visual Information Processing and Neurological Outcome in Preterm Infants

Psychological tests based on visual information processing have shown to be promising in predicting neurodevelopmental outcome in infants at risk. In the present study we prospectively investigated the early development in a group of 20 high-risk preterm infants by means of i) the Fagan Test of Infant Intelligence at 7, 9, and 12 months postterm and ii) a detailed battery for the early assessment of visual functions at 6 and 10 months postterm. The results were then correlated to the Griffiths development scales at two years. At around 7 months no correlation was found in our infants between the Fagan test and neurodevelopmental outcome, possibly as a consequence of the influence of abnormal oculomotor behaviour. At around 9 months most of the visual abnormalities were no more present and the Fagan test was significantly correlated with the outcome. At 12 months postterm a decline of the predictive value of the FTII was observed. In conclusion, nine months postterm age appears to be the best age for the early assessment of neurodevelopmental outcome in high-risk preterm infants, as the maturation of the attentional and visual systems allows a more reliable evaluation.

A pilot study on umbilical venous level of natriuretic peptides in preterm infants and their relation to periventricular leukomalacia and antenatal complications

The aim of this study was to determine the relation between umbilical venous levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in preterm infants, and the development of periventricular leukomalacia (PVL) and antenatal complications. Umbilical venous blood samples were obtained from 19 preterm infants with gestational age between 27 and 32 weeks. Cystic PVL was seen in four of them on ultrasonography. Several maternal variables were also investigated. There were no significant differences in ANP or BNP level between infants with and without PVL. Both ANP and BNP levels were significantly higher in infants with antenatal magnesium administration than in those without. Umbilical venous levels of natriuretic peptides were not useful to predict neurological outcome in preterm infants.