Periventricular Echodensities Research Articles

Neonatal periventricular leukomalacia: current perspectives

Neonatal periventricular leukomalacia: current perspectives Kunal P Ahya,1 Pradeep Suryawanshi2 1Department of Neonatology, Maahi Newborn Care Centre, Rajkot, Gujarat, 2Department of Neonatology, BVDU Medical College, Pune, Maharashtra, India Abstract: Significant advances in the neonatal ICU have improved the survival of extreme premature neonates; with this comes the importance of intact survival. Periventricular leukomalacia (PVL) is the commonest white matter brain injury in preterm infants. It has a typical distribution at the watershed areas adjacent to the lateral ventricles. PVL occurs because of ischemic injury to periventricular oligodendrocytes of the developing brain. It can be detected by cranial ultrasonography (CUS) as initial periventricular echodensities, followed later by cystic formation. Recent magnetic resonance imaging studies have shown that it helps in early visualization of PVL and also detection of non-cystic form of PVL, which is not picked up by CUS. It is the commonest cause of cerebral palsy, intellectual impairment or visual disturbances. Currently, no medical treatment is available for PVL; prevention and close developmental follow-up are the only options. Keywords: periventricular leukomalacia, preterm brain injury, cranial ultrasonography

Risk factors for brain damage among preterm twins

Aim: To evaluate the perinatal and postnatal risk factors for various brain pathologies among preterm twins.Methods: Retrospective data of 104 twin pairs of which one of the siblings had evidence of abnormal head ultrasound (HUS) and its co-twin with normal HUS served as control.Results: Abnormal HUS consisted of periventricular echodensities among 69 infants, intraventricular hemorrhage among 28 infants, cystic periventricular leukomalacia among 10 infants, and other parenchymal brain pathologies among 5 infants. Perinatal and postnatal complications were similar between study and controls. Siblings with severe brain pathologies were ventilated for longer time over their co-twins. In 10 out of 11 cases of discordant twins (≥20%) with severe brain pathology, the severe pathology was recorded in the larger sibling.Conclusions: Our study results, which included matched preterm twin pairs for study/control groups to evaluate risk factors for the overall evidence of brain injury, could not determine specific risk factors for these brain pathologies. The finding that severe brain pathologies were more common among the larger co-twin requires further study of and attention to short- and long-term outcomes and the potential conflicts that may arise.

Risk factors for periventricular echodensities and outcomes in preterm infants

Objectives: To determine the incidence, risk factors and outcomes associated with transient and/or persistent periventricular echodensities (PVED) among preterm infants.Methods: Medical records of preterm infants born at ≤ 32 weeks gestational age (GA) with PVED and no other brain pathology were reviewed and compared to matched control infants in a case-controlled retrospective study. Neurodevelopmental outcomes at 8–24 months corrected age were documented.Results: A 17.8% incidence of PVED was recorded, with the highest incidence of 30–40% recorded at 29–31 weeks GA. Study and control groups were similar for all maternal parameters and neonatal morbidities, except for a higher incidence of respiratory distress syndrome among the study group. PVED at one month of age was predicted by 5 min Apgar score < 7 [OR = 33.78 (CI 2.94–388.06, p = 0.005)]. PVED was not associated with long-term neurodevelopmental disability.Conclusions: No risk factors or specific associated morbidities were identified among preterm infants with transient PVED. PVED at one month of age was predicted by low 5 min Apgar scores, possibly suggesting different pathogenesis or timing between the groups. Long-term outcome studies are needed to determine PVED impact.

Accuracy of Transcranial Ultrasound in the Detection of Mild White Matter Lesions in Newborns

Cranial Ultrasound (cUS) may not be sensitive enough to detect subtle white matter (WM) injuries. Our study compared serial cUS with MRI at term equivalent age (TEA) to determine if it is possible to identify an ultrasound representation of subtle diffuse WM injuries such as punctate lesions (PWMLs) and diffuse excessive high signal intensity (DEHSI). Fifty-six very preterm infants were scanned sequentially from birth to TEA, an MRI was performed at TEA. Each echodensity found on cUS was classified as absent, transient (≤7 days), or prolonged (>7 days). A transient periventricular echodensity was detected in seven infants (12.5%), and a prolonged echodensity in 15 (26.8%). MRI examinations were performed in all 56 infants. No altered signal intensity was found in 18 infants (32.1%). DEHSI was detected in 14 infants (25%), and PWMLs were detected in eight babies (14.3%). Both abnormalities were found in 16 infants (28.6%). The positive predictive values of the prolonged echodensity for DEHSI and PWMLs were 86.7% and 46.7% respectively. However, a significant statistical correspondence (p=0.002, Odds Ratio 11.9) was found comparing DEHSI with cUS abnormal echodensities. Serial cUS during the neonatal period in preterm infants is essential and cannot be replaced with MRI at TEA. MRI seems to be more reliable in detecting mild or moderate WM abnormalities. However, serial cUS performed by an experienced neonatologist can provide valuable information on early WM changes such as prolonged echodensities that could potentially lead to a diffuse injury.

A Proposal to Reduce Congenital Cerebral Palsy

Aims: To clarify the feasibility to arrest preterm labor to prevent the periventricular leukomalacia (PVL) and Cerebral Palsy (CP) by the study on the developing mechanism of labor contractions. Rational: Fetal periventricular echo density (PVE) precedes preterm neonatal PVL and CP in 18% of preterm fetuses whose PVE persisted until preterm births. Since no treatment of neonatal PVE appeared immediately after preterm birth was established, another strategy is proposed to prevent preterm neonatal PVE to cease preterm labor until the full term delivery, because no CP developed in full term delivery in our report. Recently, we studied the positive feed-back loop of uterine contraction to the brain by nerves between the uterus and hypothalamus, developing regular labor contractions. Proposal: The suppression of the nerves of positive feed-back loop by anesthesia or analgesia is our proposal to cease preterm labor until the full term delivery, where no CP was reported, i.e. the CP, corresponding to 0.2% of total births, will be reduced. Conclusion: Regular preterm labor contractions will be ceased by the paralysis of nerves in the positive feed-back loop between the uterus and hypothalamus and the full-term delivery prevents CP, due to disappeared PVE in the neonates born in full term delivery. Clinical feasibility should be investigated in further studies.

Ultrasound detection of white matter injury in very preterm neonates: practical implications

Diffuse white matter injury is not well detected by cranial ultrasonography (CUS). The aim of this study was twofold: (1) to assess in very preterm neonates the predictive values of individual CUS abnormalities for white matter injury on MRI and neurological outcome; (2) to develop a strategy optimizing CUS detection of white matter injury. Very preterm neonates (n=67; 44 males, 23 females) underwent serial CUS and single MRI. Predictive values of CUS findings for a white matter classification on MRI, individual MRI findings, and neurological outcome at 2 years corrected age were calculated. The effects of timing and frequency of CUS were evaluated. Periventricular echodensities (PVEs) predicted abnormal white matter on MRI, but absence of PVEs did not predict absence of white matter changes. Peri- and intraventricular haemorrhage (P/IVH) was highly predictive of abnormal white matter on MRI. Frequency and timing of CUS did not influence predictive values. P/IVH and abnormal ventricular size/shape were reasonably predictive of unfavourable outcome, whereas absence of CUS abnormalities predicted a favorable outcome. (1) If PVEs are present, there is a significant chance of abnormal white matter on MRI. (2) Increasing frequency of CUS does not increase its diagnostic performance for white matter injury. (3) P/IVH is highly predictive of abnormal white matter on MRI and reasonably predictive of unfavourable outcome. (4) Absence of PVEs and P/IVH on CUS does not guarantee normal white matter, but predicts a favourable outcome.

Fetal Diagnosis with Ultrasonic Actocardiogram and GLHW Tissue Characterization

ABSTRACT Actocardiogram Ultrasonic Doppler actocardiogram was simultaneous tracing of FHR and fetal movement signals on the monitoring chart, created in 1984 by Maeda. Fetal behavior was easily studied, false-positive nonreactive FHR and physiological sinusoidal FHR were differentiated, the severity of fetal CNS lesion and common fetal disorders were determined, short and long-term outcomes were diagnosed in multiple grades GLHW It is clinical tissue characterization by common ultrasonic B-mode apparatus. Placental tissue was characterized and grade-3 placenta was detected. Placental origin of FGR was diagnosed and meconium stained turbid amniotic fluid was differentiated from clear fluid. Fetal periventricular echodensity preceding neonatal PVL was analyzed; 96% of fetal lung immaturity was noninvasively detected endometrial; benign hyperplasia, carcinoma, benign ovarian mass and malignancy were differentiated.

563 O Audit of the Use of Cerebral Function Monitoring (CFM) in the Management of Term Neonates with Encephalopathy

Objectives: To determine the indications for cerebral function monitoring, the characteristics of babies who had CFM and their outcomes at discharge. Methods: The records of all term newborn babies born between June 2006 - April 2009 who underwent cerebral function monitoring were reviewed. Results: Sixty six term (55% male) babies underwent cerebral function monitoring. Their mean GA was 39.2±1.6wk. The average birth weight was 3.09±0.75kg. 58% of these babies were delivered operatively. The apgar scores were 4± 3, 1min, 6.2± 2.8 ,5min and 7 ± 2.6 ,10min. 46% of these babies were intubated at birth. 43% of the babies had clinical seizures. 3 groups of babies were identified: Group 1- 11 babies had both the lower margin of CFM trace less than 5µV and the upper margin less than 10µV. Group 2- 8 babies had the lower margin less than 5µV but upper margin higher than 10µV. Group 3 - 46 babies had appropriate voltages on CFM tracing. 14 babies from groups 1&2 had moderate or severe encephalopathy and 2 had normal neurological signs at discharge. Normal CFM tracing in encephalopathic babies obviated the need for neuro-protective treatment. CFM was useful in evaluating encephalopathic babies from other causes. These included persistent hypoglycaemia, cortical haemorrhage, periventricular echodensities, kernicterus, propionic acidaemia, middle cerebral artery infarct, generalised hypotonia of unknown cause and moebius syndrome. Conclusion: Majority of babies with encephalopathy had a CFM trace with normal voltages. It is an important tool in the clinical assessment of term neonates with encephalopathy.

Placental histology related to fetal brain sonography

BackgroundChronic hypoxia and inflammatory processes can induce placental disturbances that may indirectly lead to perinatal brain injury.ObjectiveTo study histological features of the placenta in relation to echogenicity changes in the...

Neuroimaging in very preterm infants

Cranial ultrasonography (cUS) and MRI are the preferred modalities used to image the neonatal brain. Both have their specific contributions and advantages. A neuroimaging study, including sequential cUS and single MRI, was performed in a cohort of very preterm infants (gestational age &lt;32 weeks). The major aims were: to study brain imaging findings and to assess the incidences of brain abnormalities and the relationship between brain abnormalities and perinatal clinical parameters; to compare cUS and MRI findings; to describe imaging findings of the thalami and basal ganglia; and to study the reliability of cUS for detection of (diffuse) white matter injury. Patients &amp; methods: Very preterm infants, born during a 1.5-year period, were eligible if there were no exclusion criteria (i.e., metabolic and genetic disorders, or infections and/or congenital malformations of the CNS). Sequential cUS was performed from admission until discharge and on the day of the MRI following a standardized protocol. MRI (3 Tesla) was performed around or shortly after term equivalent age (TEA). Results: A total of 133 infants were included. The mean number of cUS scans per infant was 8.3 (range: 2–23). MRI was performed in 113 infants at a mean postmenstrual age of 44.7 weeks (range: 40.0–55.9). During admission we found periventricular echodensities and intraventricular hemorrhage in 80 and 30% of infants, respectively – both significantly associated with male gender. The incidence of lenticulo striate vasculopathy (LSV) was 19%. Around TEA, ventricular dilatation and widening of extracerebral spaces were frequent findings. In addition, MRI showed punctate white matter lesions and diffuse excessive high-signal intensity. MRI detected subtle white matter lesions more effectively, whereas cUS was better for the detection of LSV, calcifications and germinolytic and plexus cysts. Diffuse, subtle echogenicity of the basal ganglia and thalami was observed in the majority of infants with normal MRI findings in this area. Focal deep gray matter lesions were only rarely encountered. Conclusions: In very preterm infants, frequent, sequential cUS is an excellent tool to image and follow the brain throughout the neonatal period and detects some lesions and transient changes more effectively than MRI. Single MRI provides invaluable and detailed additional information on the growth and development of, and injury to, the brain. Sequential cUS throughout the neonatal period and a single MRI around TEA are therefore warranted. Bilateral, diffuse and subtle echogenicity in the deep gray matter on cUS probably reflects (normal) maturational processes in the immature brain. With the exception of LSV, focal lesions in the deep gray matter are rare and need to be distinguished from benign phenomena in the deep gray matter. Sequential high-quality cUS during the neonatal period predicts severe white matter injury, but is less predictive of mild-to-moderate white matter injury around TEA.

Cerebral Oxygen Saturation and Extraction in Preterm Infants With Transient Periventricular Echodensities

Our aim was to determine regional cerebral tissue oxygen saturation and fractional tissue oxygen extraction in preterm infants with transient periventricular echodensities. We hypothesized that as a result of reduced cerebral perfusion, regional cerebral tissue oxygen saturation will be lower and fractional tissue oxygen extraction will be higher during the first days after birth. This was a prospective, observational study of 49 preterm infants (gestational age median: 30.1 weeks [26.0-31.8 weeks]; birth weight median: 1220 g [615-2250 g]). We defined transient periventricular echodensities as echodensities that persisted for >7 days. Regional cerebral tissue oxygen saturation was measured on days 1-5, 8, and 15 after birth. Fractional tissue oxygen extraction was calculated as (transcutaneous arterial oxygen saturation--regional cerebral tissue oxygen saturation)/transcutaneous arterial oxygen saturation. Transient periventricular echodensities were found in 25 of 49 infants. During the first week we found no difference between the 2 groups for cerebral tissue oxygen saturation and fractional tissue oxygen extraction values. On day 15 after birth, cerebral tissue oxygen saturation was lower in preterm infants with transient periventricular echodensities (66%) compared with infants without echodensities (76%) (P = .003). Fractional tissue oxygen extraction in infants with transient periventricular echodensities (0.30) was higher than fractional tissue oxygen extraction in infants without transient periventricular echodensities (0.20) (P < .001). The differences could not be explained by confounding variables. Persistent transient periventricular echodensities may be associated with increased cerebral oxygen demand after the first week after birth, which is contrary to our hypothesis. Cerebral oxygenation may be involved in the recovery of perinatal white matter damage.

Periventricular Echodensity Measured with the Integrated Backscatter System: From a Qualitative Assessment to a Quantitative Approach

Background: The degree of periventricular white matter echodensity in preterm infants has been utilized as a sign of the early ultrasonographic appearance of periventricular leukomalacia, and this has been called periventricular echodensity (PVE). Objectives: The aim of this study was to quantitatively measure PVE utilizing a new method which is called calibrated integrated backscatter (calibrated IB). Methods: Eighty-eight preterm infants (extremely low birth weight infants, n = 17; very low birth weight infants, n = 26; low birth weight infants, n = 45) without any CNS abnormality were enrolled. IB is the returned sound pressure against supersonic waves sent from an ultrasonographic machine. The IB of the choroid plexus and periventricular white matter in the subrolandic area were measured on a parasagittal cerebral image. The degree of PVE was defined by subtracting the IB of the choroid plexus from that of the periventricular white matter in the subrolandic area (calibrated IB of PVE). Results: The intraobserver and interobserver correlations were both excellent (between 0.87 and 0.98 as correlation coefficients). There was a trend for the calibrated IB of PVE to decrease in accordance with time after birth, with a significant difference in very low birth weight and low birth weight infants. Conclusions: The objectively measured brightness of PVE was comparable to that of the choroid plexus irrespective of the size of the infants. Measurement of the calibrated IB of PVE might be a reliable method to assess PVE.

Risk factors for periventricular leukomalacia

To identify risk factors implicated in the development of periventricular leukomalacia (PVL) and to evaluate the possible association between PVL with neonatal morbidity. Retrospective case control study. Medical records of neonates admitted to a University Hospital between January 2000 and December 2005. Sixty-nine neonates with PVL born at gestational ages from 24 to 34 weeks. Forty-three of these had a cystic form of PVL (cPVL), whereas 26 had transient periventricular echodensities (PVE). Each case was matched for gestational age and year of birth with one control. The maternal and neonatal medical records were searched. All data was compared between cases with PVL and controls, as well as between cases with cPVL and those with PVE. Stepwise logistic regression analysis was conducted to identify the independent predictors of PVL. Neonates with PVL suffered more frequently from intraventricular hemorrhage (IVH), respiratory distress syndrome type I (RDS I), seizures, sepsis, required more days of both mechanical ventilation and oxygen administration, while the duration of their hospitalization was longer compared to controls. Also, they were born more frequently to mothers who suffered from preterm premature rupture of membranes (PPROM) and clinical chorioamnionitis. We found that male gender, PPROM, preeclampsia, hypocarbia and IVH were independently associated with PVL. This study revealed that preterm neonates born to mothers with PPROM or preeclampsia, as well as neonates who presented with hypocarbia or suffered from IVH, appeared to be at high risk for the development of PVL.

A Pilot study to determine whether external stabilisation of the chest wall reduces the need for mechanical ventilation in preterm infants

Objectives . This was a pilot study to determine whether external stabilisation of the chest wall with a splint reduces the need for mechanical ventilation in preterm infants, within the first 7 days after study entry. Design. This was a non-blinded prospective randomised controlled study. After consent was obtained, babies were randomised into a chest splint or control group. Setting and time . The study was conducted in the neonatal units of Johannesburg and Chris Hani Baragwanath hospitals between January 2004 and December 2005. Subjects . Preterm infants with a birth weight above 1 000 g with respiratory distress syndrome requiring more than 25% supplemental oxygen to maintain oxygen saturation above 90% during the first day of life. Outcome measures . The primary outcome measure was the need for mechanical ventilation within 7 days of study entry; secondary outcome measures were survival at 30 days, air leak and intraventricular haemorrhage. Results. There were 40 infants enrolled, 19 randomised to the chest splint group and 21 to the control group. Demographic characteristics were comparable, although the splint group required significantly more supplemental oxygen at enrolment. Four of the 19 infants in the splint group and 5 of the 21 controls required mechanical ventilation (not significant). There was no air leak in any of the study subjects during the study period. Twelve infants in each group had cranial ultrasound scans: there was one grade 3 intraventricular haemorrhage, one periventricular echodensity and one germinal matrix cyst in each group. Three of the 21 controls and 2 of the 19 splint group infants died within the first 30 days; no death was related to the chest splint. There were no local complications related to the chest splint, such as skin rash or pressure sores. Conclusion . This small study did not demonstrate any reduction in the need for ventilation with the use of the chest splint. Use of the splint was not associated with any complications and therefore appears to be safe to use. Further studies with larger numbers are warranted.

Regression of fetal cerebral abnormalities by primary cytomegalovirus infection following hyperimmunoglobulin therapy

To assess the effects of maternal and intra-amniotic hyperimmunoglobulin (HIG) infusions among cytomegalovirus (CMV) infected fetuses with ultrasound abnormalities following a primary CMV infection. The subjects were fetuses with CMV-associated cerebral and other ultrasound abnormalities. Three mothers were treated with HIG infusions during pregnancy and two were untreated. Fetal ventricle size, organ echodensity and placental thickness were measured by ultrasound before and after HIG infusions. The children were evaluated between 3 and 7 years of age. The ventriculomegaly of all three fetuses of HIG-treated mothers regressed and the ascites, hepatic echodensities, periventricular echodensities, and intestinal echodensities disappeared. Their sensorial, mental and motor development was normal at 4, 4.7, and 7 years of age. In contrast, both infants born of untreated mothers had signs and symptoms of severe CMV cerebropathy. The outcomes of the infants born to HIG-treated mothers support the efficacy of HIG as a treatment for CMV-infected fetuses with ultrasound cerebral abnormalities.

Prevalence of neonatal ultrasound brain lesions in premature infants with and without intrauterine growth restriction

To compare the prevalence of transient periventricular echodensities (TPE), periventricular leukomalacia (PVL) and haemorrhagic brain lesions (HBL) in singleton intrauterine growth-restricted (IUGR) infants and in those appropriate for gestational age (AGA). Thirty-five IUGR and 35 AGA singleton infants born between 24- and 34-week gestational age were studied. The presence of TPE, PVL and HBL was assessed with ultrasound (US) at day 3 (US-I), 2 weeks (US-II) after delivery and at term-equivalent age (US-III). IUGR neonates had an increased prevalence of TPE at US-I (18/35 vs. 8/35, p= 0.02) and an increased prevalence of PVL at US-II (8/32 vs. 1/31, p = 0.03) and US-III (8/29 vs. 1/29, p = 0.02). No significant differences in the prevalence of HBL were found between the two groups. IUGR is associated with an increased prevalence of white matter damage on US brain scans in preterm neonates.

Changes in echogenicity in the fetal brain: a prevalence study in fetuses at risk for preterm delivery

To study the incidence of echodensities in the periventricular white matter, ventricular system, basal ganglia and thalamus of the brain in fetuses at risk for preterm delivery. This was a prospective study of 124 fetuses with a gestational age between 26 and 34 weeks in pregnancies affected by either pregnancy-induced hypertensive disorders or preterm labor. Transvaginal ultrasound examination of the fetal brain in coronal and sagittal planes was performed weekly until delivery and the neonatal brain was examined within 24 h after delivery. In 66% of all fetuses, echodensities were found in one or more areas of the brain. They were present in the periventricular area in 52% of cases, the intraventricular area in 18% and in the basal ganglia and thalamus area in 28%. Changes in echogenicity were seen throughout the entire gestational-age period studied. Of the periventricular echodensities that exceeded in echodensity that of the choroid plexus, at least 50% persisted after delivery; at least 38% of the intraventricular echodensities and at least 32% of the basal ganglia and thalamus echodensities persisted after delivery. In high-risk fetuses, echodensities are a frequent finding in several areas in the brain. How far these echodensities are related to future outcome of the infant needs to be investigated.

Minor neurological dysfunction, cognitive development and somatic development at the age of 3 to 11 years in very‐low‐birthweight infants with transient periventricular echodensities

To determine, using strict exclusion criteria, whether transient periventricular echodensities (TPE) in very-low-birthweight infants lead to minor neurological dysfunction and problems in cognitive and somatic development in children without major neurological impairments. 23 children with TPE were matched to 23 children without TPE. Exclusion criteria were small for gestational age, microcephaly at birth, diplegia, asphyxia, psychomotor retardation, intraventricular haemorrhage grade III/IV, major surgical interventions and malformations. The Kaufman Assessment Battery for Children, Draw-a-Man Test and neuropaediatric examination were used for evaluation. There were no differences in demographic data, growth and socio-economic status. Significant differences with lower results in the TPE group were found in fine motor skills and in the Draw-a-Man Test. In the Kaufman Assessment Battery for Children, all subscales were below average in the TPE group, except the sequential processing scale. In the control group, all subscales were within the average range. By using strict exclusion criteria to eliminate other risk factors for minimal neurological dysfunction and poor cognitive development, we were able to focus on the effect of TPE. TPE seem to affect cognitive development and cause minor neurological dysfunction.

Periventricular echodensities in preterm infants

Sir, Periventricular echodensities (PVE) in preterm infants are not necessarily abnormal. It has been found that periventricular “blush” is very common [1, 2]. The findings of the study by Resch and associates [3] would be significantly strengthened were there no serious limitations to it. Readings should have been made by more than one observer, because in a retrospective study the quality of the images often varies. The assertion that a neuroradiologist’s interpretation was “confirmed” by a pediatric radiologist suggests an unusual 100% agreement. Grades of severity of PVE were based on comparison of the areas of PVE with the density of the choroids plexus. This is subjective, so that the use of more than one reader is critical. In fact, as I look at Fig. 2 of the article I wonder whether there are early low density areas within the PVE in the reproduction of the parasagittal image. The method of selection of preterm infants for the study is not clear. I assume that PVEs were not universal, otherwise the finding would lead me to the conclusion that at least in some cases it represented the well-known “blush”. It is surprising, therefore, that those infants without PVE were not chosen as controls. Inclusion of controls would give the article the needed reliability. The text and Tables 3 and 4 show that persistence of echodensities rather than grade was the main factor of adverse neurodevelopmental outcome. Numbers are small and evidently a Fisher exact test was used instead of the more reliable chi-square test. Nevertheless, the small sample makes the power of the test low (or the likelihood of type II or beta error high). This means that there might indeed be a significant difference missed between grades 1 and 2 because there were so few patients studied. Moreover, I found no consideration of the combined effect of both the grade and the persistence of PVE. The mixed information regarding the significance of PVE in premature infants, as quoted in the authors’ review of the literature on the subject, is the result of small numbers, subjective criteria, and absence of controls. Unfortunately, these problems, many admittedly difficult to control, prevent conclusions being drawn from this report along with others regarding the significance of demonstrating PVE in neonatal cranial sonograms.

Correlation of grading and duration of periventricular echodensities with neurodevelopmental outcome in preterm infants

Transient periventricular echodensities (PVE) in preterm infants affect neurodevelopmental outcome. To correlate the duration and grading of PVE with neurodevelopmental outcome. A retrospective, single-centre cohort study of infants with PVE diagnosed by ultrasonography from 1995 to 2000 with blinded grading and recognition of duration of PVE. A total of 72 infants (median gestational age 32 weeks, median birth weight 1,668 g) were diagnosed as having PVE. Minor neurological abnormalities were diagnosed in seven (10%), cerebral palsy in six (8%), developmental delay in seven (10%), and mild mental retardation in two (3%) of the infants. Differences regarding adverse outcome were not significant between infants with severity grade 1 compared to severity grade 2 (16% and 22%, respectively). There was a significant increase in adverse neurodevelopmental outcome with increasing duration of PVE. Of 33 infants with duration of PVE<7 days, 1 (3%) had an adverse neurodevelopmental outcome, compared to 6 (24%) of 25 infants with a duration of PVE of 7-14 days, and 6 (43%) of 14 infants with a duration of PVE>14 days (P<0.002, RR 7.920, 95% CI 1.017-61.661; P<0.001, RR 14.143, 95% CI 1.871-106.895, respectively). The duration, but not the grading, of transient PVE was significantly correlated with neurodevelopmental outcome.