Periventricular Leukomalacia Grade Research Articles

ON THE QUESTION OF HEARING IMPAIRMENT IN PREMATURE CHILDREN WHO HAVE EXPERIENCED OXIDATIVE STRESS AT BIRTH

Introduction. Hearing impairment (HI) occupies an important place among perinatal pathology. According to theWHO, the frequency of severe hearing impairment is observed in 1–2 per 1000 newborns and in 15% of newborns whorequired intensive therapy after birth. Mild and moderate HI occurs in 1–2% of children with perinatal pathology.The aim of the work is to study the predictors of hearing impairment and the factors that determine the severityof deafness in children aged 2–3 months who suffered oxidative stress at birth.Material and methods. 131 cases of observation of newborns of 27–36 weeks of gestation with HI in Communalnonprofit enterprise «City perinatal center» Kharkiv city council were analyzed. Children whose families had casesof HI were excluded from the study. During the observation, the audiological examination was carried out in thenewborn period (primary examination) and at 2–3 months of age. To meet the aim of the work, alternative groupswere formed: Group I (n=51) with unilateral and Group II (n=80) with bilateral hearing impairment.To determine the predictors of the severity of PS in the comparison groups, the factors determining deafnesswere studied, and their prognostic informativeness was established. The t-Student and φ-Fisher criteria weredetermined, the Wald-Henkin heterogeneous sequential procedure algorithm was used, predictive coefficients (PC)and informativeness (I) were determined.By decision of the Bioethics Commission № 3 dated March 21, 2023, the study materials comply with the TokyoDeclaration of the World Medical Association, the International Recommendations of the Helsinki Declaration onHuman Rights, the Council of Europe Convention on Human Rights and Biomedicine, the Laws of Ukraine, and therequirements of the Code of Ethics of a Doctor of Ukraine.The study was carried out within the framework of the scientific research work of the Department of Pediatrics№ 3 and Neonatology of KhNMU «Study of peculiarities of the course of oxidant stress diseases in newborns» 2022–2024 (state registration № А22U000025).Results. Factors of obstetric and somatic anamnesis of the mother did not influence the nature of HI in the child.Among the complications of pregnancy and childbirth in the anamnesis of children with bilateral HI, dysfunction ofplacenta was more often observed 33.8 and 13.7 % (р<0.001), threat of abortion 30.0 and 17.6 % (<0.05), anemiapregnant women 31.2 and 13.7 % (p<0.001), fetal distress 56.2 and 37.3 % (p<0.01), cesarean delivery 68.8 and 47.1% (p <0.001), especially regarding fetal distress – 67.3 and 29.2 % (р<0.001).The frequency of bilateral HI in children is inversely proportional to gestational age and birth weight and isassociated with a low Apgar score. Sexual dimorphism was revealed: girls predominated in the group with bilateralhearing loss, 56.2 and 35.3 % (р<0.001). Children with bilateral HI more often required surfactant therapy 78.8 and33.3 % (p<0.001), as well as longer respiratory support and oxygen therapy.In the study, bilateral HI was more common in children with diseases whose pathogenesis is closely relatedto oxidative stress: periventricular leukomalacia 55.0 and 7.8 % (<0.001); bronchopulmonary dysplasia (BPD)of the 2nd and 3rd degree: 23.7 and 2.0 % (p<0.001) and 23.7 and 0 % (p<0.001), respectively; retinopathy ofprematurity grade 2–3 42.5 and 17.6 % (р<0.001); with an PDA 81.3 and 41.2 % (p<0.001), including when surgicalclosure was necessary, 18.5 and 9.5 % (p<0,05). The highest informativeness of hearing impairment in childrenwho have undergone oxidative stress belongs to the following characteristics: gestational age (6.14), total durationof mechanical ventilation (5.54), body weight (5.44), BPD (5.4), duration of mechanical ventilation in mode ofnormoventilation (4.1), duration of oxygen therapy (3.91), PDA (3.72).The most significant prognostic factors of bilateral hearing impairment: the presence of BPD 2–3 stages. (-13.8);intraventricular hemorrhage (IVH) 2–3 st. (-12.4); total duration of ventilator ≥21 days (-10.33); gestation period≤29 weeks (-8.6); periventricular leukomalacia (PVL) 2–3 st. (-8.48); duration of oxygen therapy ≥21 days (-7.38);body weight (-6.94).Conclusions: The most significant prognostic factors of bilateral hearing impairment: the presence of BPD 2–3st. (-13.8); IVH 2–3 st. (-12.4); total duration of ventilator ≥21 days (-10.33); gestation period ≤29 weeks (-8.6);periventricular leukomalacia 2–3 st. (-8.48); duration of oxygen therapy ≥21 days (-7.38); body weight (-6.94), etc.Bilateral hearing impairment is predicted in newborns based on the presence of gestational immaturity (gestationalterm ≤ 29 weeks), BPD grade 2–3, IVH grade 2–3, total duration of mechanical ventilation and oxygen therapy > 21days, PVL grade 2–3. In our study, no reliable relationship was found between the nature of the hearing impairment of aprematurely born child and the somatic and obstetric anamnesis of the mother. Gender characteristics among prematureinfants with bilateral HI were characterized by the predominance of the female gender, 56.2 and 35.3 % (р<0.001).

The Impact of Intraventricular Hemorrhage and Periventricular Leukomalacia on Mortality and Neurodevelopmental Outcome in Very Preterm and Very Low Birthweight Infants: A Prospective Population-based Cohort Study

To survey the incidence of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) by gestational age and to report the impact on mortality and neurodevelopmental outcome in very preterm/very low birthweight infants. This was a population-based cohort study of 1927 very preterm/very low birthweight infants born in 2014-2016 and admitted to Flemish neonatal intensive care units. Infants underwent standard follow-up assessment until 2 years corrected age with the Bayley Scales of Infant and Toddler Development and neurological assessments. No brain lesion was present in 31% of infants born at <26weeksof gestation and 75.8% in infants born at 29-32weeksof gestation. The prevalence of low-grade IVH/PVL (grades I and II) was 16.8% and 12.7%, respectively. Low-grade IVH/PVL was not related significantly to an increased likelihood of mortality, motor delay, or cognitive delay, except for PVL grade II, which was associated with a 4-fold increase in developing cerebral palsy (OR,4.1; 95% CI,1.2-14.6). High-grade lesions (III-IV) were present in 22.0% of the infants born at <26weeksof gestational and 3.1% at 29-32weeksof gestation, and the odds of death were ≥14.0 (IVH: OR,14.0; 95% CI,9.0-21.9; PVL: OR,14.1; 95% CI,6.6-29.9). PVL grades III-IV showed an increased odds of 17.2 for motor delay and 12.3 for cerebral palsy, but were not found to be associated significantly with cognitive delay (OR,2.9; 95% CI, 0.5-17.5; P=.24). Both the prevalence and severity of IVH/PVL decreased significantly with advancing gestational age. More than 75% of all infants with low grades of IVH/PVL showed normal motor and cognitive outcome at 2 years corrected age. High-grade PVL/IVH has become less common and is associated with adverse outcomes.

Mortality and Morbidity in Premature Infants: An East and West Comparative Study.

Survival of preterm infants differs dramatically depending on birthplace. No previous studies have compared outcomes of preterm infants between low middle-income and high-income countries such as India and the United States. The purpose of this study is to evaluate differences in care practices, resources, mortality, and morbidities in preterm infants with birth weight 700 to 1,500 g between two major neonatal centers in these countries. This is a retrospective cohort study with de-identified data from Fernandez Hospital (FH) in Hyderabad, India, and Texas Children's Hospital (TCH) in Houston, TX, for infants born January 2016 to December 2018, and weighing 700 to 1,500 g at birth. The primary outcome was death before hospital discharge. Of 1,195 infants, 736 were admitted to FH and 459 were admitted to TCH. After controlling for differences in gestational age, small for gestational age, and antenatal corticosteroid use, TCH patients had lower mortality before hospital discharge (adjusted odds ratio [aOR] = 0.28, 95% confidence interval [CI]: 0.16-0.48, p < 0.001) and more bronchopulmonary dysplasia (BPD; aOR = 2.2, 95% CI: 1.51-3.21, p < 0.001). The composite outcome of death or BPD and death or any major morbidity (BPD or intraventricular hemorrhage grade II or more or periventricular leukomalacia grade II or more or retinopathy of prematurity requiring treatment) were not different. In this study, TCH infants had decreased odds of death before hospital discharge compared with FH but higher odds of BPD, which may be related to increased survival and differences in care practices. · Few studies compared outcomes of premature infants between different high-income countries.. · There are no studies comparing preterm infants between low middle-income and high-income countries such as India and the United States.. · This study evaluated detailed comparison of care practices and infrastructure of NICUs in India and United states..

Temporizing management vs immediate delivery in early‐onset severe preeclampsia between 28 and 34 weeks of gestation (TOTEM study): An open‐label randomized controlled trial

IntroductionThere is little evidence to guide the timing of delivery of women with early‐onset severe preeclampsia. We hypothesize that immediate delivery is not inferior for neonatal outcome but reduces maternal complications compared with temporizing management.Material and methodsThis Dutch multicenter open‐label randomized clinical trial investigated non‐inferiority for neonatal outcome of temporizing management as compared with immediate delivery (TOTEM NTR 2986) in women between 27+5 and 33+5 weeks of gestation admitted for early‐onset severe preeclampsia with or without HELLP syndrome. In participants allocated to receive immediate delivery, either induction of labor or cesarean section was initiated at least 48 hours after admission. Primary outcomes were adverse perinatal outcome, defined as a composite of severe respiratory distress syndrome, bronchopulmonary dysplasia, culture proven sepsis, intraventricular hemorrhage grade 3 or worse, periventricular leukomalacia grade 2 or worse, necrotizing enterocolitis stage 2 or worse, and perinatal death. Major maternal complications were secondary outcomes. It was estimated 1130 women needed to be enrolled. Analysis was by intention‐to‐treat.ResultsThe trial was halted after 35 months because of slow recruitment. Between February 2011 and December 2013, a total of 56 women were randomized to immediate delivery (n = 26) or temporizing management (n = 30). Median gestational age at randomization was 30 weeks. Median prolongation of pregnancy was 2 days (interquartile range 1‐3 days) in the temporizing management group. Mean birthweight was 1435 g after immediate delivery vs 1294 g after temporizing management (P = .14). The adverse perinatal outcome rate was 55% in the immediate delivery group vs 52% in the temporizing management group (relative risk 1.06; 95% confidence interval 0.67‐1.70). In both groups there was one neonatal death and no maternal deaths. In the temporizing treatment group, one woman experienced pulmonary edema and one placental abruption. Analyses of only the singleton pregnancies did not result in other outcomes.ConclusionsEarly termination of the trial precluded any conclusions for the main outcomes. We observed that temporizing management resulted in a modest prolongation of pregnancy without changes in perinatal and maternal outcome. Conducting a randomized study for this important research question did not prove feasible.

The Neurological Outcome of Isolated PVL and Severe IVH in Preterm Infants: Is It Fair to Compare?

ObjectiveWe compared the neurological outcome of isolated periventricular leukomalacia and severe intraventricular hemorrhage in a cohort of very low birth weight infants born and managed at single tertiary-care center in Saudi Arabia. MethodsWe undertook a descriptive retrospective chart review of the neurological status of very low birth weight infants who were born and managed over a 5-year period at King Abdulaziz Medical City, Riyadh. The neurological outcome of neonates with isolated periventricular leukomalacia and severe intraventricular hemorrhage (grades III and IV) was studied and compared in relation to developmental delay and cerebral palsy. ResultsA total of 20 patients with isolated periventricular leukomalacia and 26 with severe intraventricular hemorrhage (grades III and IV) were identified for this study. Of 20 patients with isolated periventricular leukomalacia, 9 (45%) had good developmental outcome and 11 (55%) had bad developmental outcome. Of 26 patients of severe intraventricular hemorrhage, 14 (54%) had good developmental outcome and 12 (46%) had bad developmental outcome (P = 0.55). Significant motor neurological deficit affecting function is distributed as follows: 11/20 (55%) in the isolated periventricular leukomalacia group and 7/26 (27%) in the severe intraventricular hemorrhage group (P = 0.05). Cerebral palsy was diplegic in 7/11 (64%) and quadriplegic in 4/11 (36%) in the isolated periventricular leukomalacia group, and hemiplegic 3/7 (43%), diplegic in 1/7 (14%), and quadriplegic in 3/7 (43%) in the severe intraventricular hemorrhage group (P = 0.03). Distribution of the neurological outcome according to periventricular leukomalacia grade was as follows: for periventricular leukomalacia grade I (n = 8), 6/8 (75%) had good neurological outcome and 2/8 (25%) had bad neurological outcome. In periventricular leukomalacia grade II (n = 4), good neurological outcome was seen in three patients (75%) and bad neurological outcome was seen in one patient (25%). All patients (n = 8) with periventricular leukomalacia grade III had bad outcome (P < 0.01). ConclusionAbout half of patients with isolated periventricular leukomalacia and severe intraventricular hemorrhage had a poor developmental outcome. However, the severity of cerebral palsy was greater in the isolated periventricular leukomalacia patients and correlates highly with periventricular leukomalacia grade. Symmetrical diplegic cerebral palsy is the most common motor deficit associated with isolated periventricular leukomalacia, whereas asymmetrical hemiplegic cerebral palsy is seen exclusively with severe intraventricular hemorrhage.

Cerebral Injury in Twin–Twin Transfusion Syndrome Treated With Fetoscopic Laser Surgery

To estimate the incidence and risk factors for cerebral lesions in monochorionic twins with twin-twin transfusion syndrome treated with fetoscopic laser surgery compared with dichorionic twins. We performed a case-control study on cerebral injury detected by postnatal cranial ultrasonography in monochorionic twin neonates with twin-twin transfusion syndrome treated with a laser compared with a control group of dichorionic twin neonates matched for gestational age at birth. Severe cerebral lesions were defined as the presence of at least one of the following: intraventricular hemorrhage grade III, periventricular hemorrhagic infarction, periventricular leukomalacia grade II or greater, porencephalic cysts, arterial stroke, ventricular dilatation, or a combination of these. From 2004 until 2011, 267 twin neonates with twin-twin transfusion syndrome could be included and matched with 267 dichorionic twin neonates. Incidence of severe cerebral lesions in the twin-twin transfusion syndrome group and control group was 8.6% (23 of 267) and 6.7% (18 of 267), respectively (P=.44). Multivariable analysis revealed that only gestational age at birth was independently associated with increased risk for severe cerebral lesions (odds ratio [OR] 1.35 for each week, 95% confidence interval [CI] 1.14-1.59, P<.01). In 52.2% (12 of 23), the cerebral lesions in the twin-twin transfusion syndrome group were of antenatal origin compared with 16.7% (3 of 18) in the control group (OR 8.00, 95% CI 1.42-45.06, P=.02). Incidence of severe cerebral lesions in twin-twin transfusion syndrome treated with laser is similar to a matched control group and is independently associated with prematurity. In contrast to dichorionic twins, cerebral injury in twins with twin-twin transfusion syndrome most often occurs antenatally.

Changes in Survival and Neonatal Morbidity in Infants with a Birth Weight of 750 g or Less

Background: Improvement in perinatal and neonatal care has resulted in increased survival of extremely low birth weight (ELBW) infants. Objectives: To describe survival and neonatal morbidity in a cohort of ELBW infants, to compare two consecutive 5-year periods, and compare appropriate (AGA) with small for gestational age (SGA) infants (AGA ≧p10, and SGA <p10). Methods: Retrospective cohort study of 179 live-born infants with a birth weight (BW) of ≤750 g and gestation of ≧24 weeks, born in 1996–2000 (cohort I, n = 94) and 2001–2005 (cohort II, n = 85) in theWilhelmina Children’s Hospital Utrecht, the Netherlands. Results: During NICU stay (n = 146) 62.3% experienced infant respiratory distress syndrome (IRDS), 46.6% bronchopulmonary dysplasia, 50.7% septicemia, 34.2% periventricular leukomalacia grade I and 24.7% intraventricular hemorrhage grade I/II. IRDS grade III/IV occurred significantly more often in cohort I (p = 0.042), whereas septicemia and hyperbilirubinemia occurred more in cohort II (p = 0.045 and p = 0.001). In AGA infants mean gestation was significantly shorter (p < 0.001), and IRDS grade III/IV (p = 0.015), mechanical ventilation (p = 0.045) and patent ductus arteriosus (p = 0.003) were significantly more prevalent. Overall survival was 62%, and survival in the NICU increased from 65.8% (cohort I) to 88.1% (cohort II, p = 0.002). Survival of AGA and SGA infants did not differ, but increased with time (71.4 to 75.9% and 61.4 to 97.4%, respectively). Conclusions: Mortality of infants with a BW of ≤750 g is high, but decreased over time, especially in SGA infants. Considerable neonatal morbidity was present, especially in AGA infants, most likely due to their significantly shorter gestation.

Gross motor functional abilities in preterm‐born children with cerebral palsy due to periventricular leukomalacia

To describe the impact of periventricular leukomalacia (PVL) on gross motor function, data on 59 children (37 males, 22 females) with a gestational age (GA) of 34 weeks or less with cerebral palsy (CP) due to PVL grade I (n=20), II (n=13), III (n=25), and IV (n=1) were studied; (mean GA 29 wk 4d [SD 4 wk 6d]; mean birthweight 1318 g [SD 342]). Two independent raters used the Gross Motor Function Classification System (GMFCS) at four time points: T1, mean corrected age (CA) 9 months 15 days (SD 2 mo 6d); T2, mean CA 16 months (SD 1 mo 27 d); T3, mean CA 24 months 27 days (SD 2 mo 3d); and T4, median age 7 years 6 months (range 2 y 2 mo-16 y 8 mo). Interrater reliability and stability across time with respect to the total cohort were kappa>or=0.86 and rho>or=0.74 respectively. The association between PVL and gross motor outcome at T4 was strong (positive and negative predictive values 0.92 and 0.85 respectively). The proportion of children who remained in the same GMFCS level increased from 27% (T1-T4) to 53% (T2-T4) and 72% (T3-T4). PVL grade I to II, as diagnosed in the neonatal period, has a better functional mobility prognosis than PVL grade III-IV. These findings have implications for habilitation counselling and intervention strategies.

The Infant Behavioral Assessment and Intervention Program to support preterm infants after hospital discharge: a pilot study

In this pilot study we investigated the feasibility of The Infant Behavioral Assessment and Intervention Program (IBAIP) in a group of preterm infants. At the age of 6 months, the neurobehavioural organization and self-regulatory competence of an intervention group was compared with a control group who had received the standard follow-up care. The intervention group consisted of 13 males and seven females (mean gestational age [GA] 29.2 weeks, SD 1.3wks; mean birth weight 1232g, SD 320g). The control group consisted of 11 males and nine females (mean GA 29wks, SD 1.6wks; mean birthweight 1198g, SD 397g). Inclusion criteria were: a GA of 32 weeks and family residence in the district of Amsterdam. Exclusion criteria were: severe congenital abnormalities, intraventricular haemorrhage grade III or IV, periventricular leukomalacia grade III or IV, and infants whose mothers had a history of illicit drug use. The intervention infants received 6 to 8 IBAIP interventions at home, from discharge until 6 months of age. The Neonatal Behavioral Assessment Scale was administered at term; the Infant Behavioral Assessment (IBA) at term, 3, and 6 months of age; and the Bayley Scales of Infant Development-II at 3 and 6 months (corrected age). At 6 months, intervention infants showed less stress and more approach behaviours on the IBA compared with control infants. These promising results warrant further evaluation in a randomized controlled trial.

301 Intraventricular Haemorrhage on the Left Side of the Brain Induces Left-Handedness

Background: Prematurely born children are more often left-handed than their term born peers. It is unknown if this excess left-handedness, a marker for the extent of cerebral lateralisation, is caused by cerebral lesions.Methods: In a cohort of 221 preterm born infants (gestational age <= 32 weeks and/or birth weight <= 1500 grams), brains were serially examined in the neonatal period using cranial ultrasound (US) to detect intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL) and other abnormalities. At age 7 to 10 years, magnetic resonance imaging (MRI) was done, and hand preference and current IQ were measured. MRI and US were classified as normal, mildly abnormal, or severely abnormal, blinded to handedness data.Results: Children with severely abnormal US (IVH grade III/IV, cystic PVL grade II/III, thalamic lesion, focal infarction or haemorrhage at the level of the convexity) had an increased chance to become left-handed: odds ratio (OR) severely abnormal US versus normal US 4.1, 95% CI 1.6 to 10.0, p=0.003. This was confirmed by MRI scans at school age: OR severely abnormal MRI versus normal MRI 4.0, 95% CI 1.5 to 10.7, p=0.005. Findings were attributable to IVH. Left-sided IVH showed a higher chance for left-handedness (OR left-sided IVH versus no IVH 4.4, 95% CI 1.7 to 11.3, p=0.002), whereas right-sided IVH did not. Neonates with left-sided mild IVH (grade I and II) still showed an increased chance for left-handedness: OR mild left-sided IVH versus no IVH 4.0, 95% CI 1.5 to 10.9, p=0.007. PVL was not related to left-handedness.Conclusion: Our findings strongly indicate that even a small intraventricular haemorrhage affecting the left side of the brain induces left-handedness. This is likely related to the role of the subependymal germinal matrix in the developing brain.

The Infant Behavioral Assessment and Intervention Program to support preterm infants after hospital discharge: a pilot study

In this pilot study we investigated the feasibility of The Infant Behavioral Assessment and Intervention Program (IBAIP) in a group of preterm infants. At the age of 6 months, the neurobehavioural organization and self-regulatory competence of an intervention group was compared with a control group who had received the standard follow-up care. The intervention group consisted of 13 males and seven females (mean gestational age [GA] 29.2 weeks, SD 1.3wks; mean birthweight 1232g, SD 320g). The control group consisted of 11 males and nine females (mean GA 29wks, SD 1.6wks; mean birthweight 1198g, SD 397g). Inclusion criteria were: a GA of 32 weeks and family residence in the district of Amsterdam. Exclusion criteria were: severe congenital abnormalities, intraventricular haemorrhage grade III or IV, periventricular leukomalacia grade III or IV, and infants whose mothers had a history of illicit drug use. The intervention infants received 6 to 8 IBAIP interventions at home, from discharge until 6 months of age. The Neonatal Behavioral Assessment Scale was administered at term; the Infant Behavioral Assessment (IBA) at term, 3, and 6 months of age; and the Bayley Scales of Infant Development-II at 3 and 6 months (corrected age). At 6 months, intervention infants showed less stress and more approach behaviours on the IBA compared with control infants. These promising results warrant further evaluation in a randomized controlled trial.

Correlative value of magnetic resonance imaging for neurodevelopmental outcome in periventricular leukomalacia

The aim of this study was to evaluate the correlative value of magnetic resonance imaging (MRI) in children with periventricular leukomalacia (PVL) for neurodevelopmental outcome. MRI examinations of 89 children (46 males, 43 females) with PVL (median age 4y, range 1 to 14y) were reevaluated. PVL was graded as follows: grade I, unilateral or bilateral areas of periventricular hyperintensity (1–3); grade II, hyperintensity more than 3; grade III, hyperintense lesions more than 3 and ventricular wall irregularity; grade IV, diffuse PVL and ventricular dilatation. Localizations of PVL and brain abnormalities associated with PVL were also noted. Assignment to PVL grades on MRI was as follows: PVL I (n=22), PVL II (n=18), PVL III (n=30), and PVL IV (n=19). Cerebral palsy was slightly less common in children with PVL I and II compared with PVL III to IV. Motor function was normal in 50% of children with PVL grade I, but severely impaired in 73.7% of children with PVL grade IV. Results of visual function were normal in all with PVL I, but pathological in 42.1% of patients with PVL IV. Developmental tests were appropriate for age in 75% of patients with PVL I, but significantly delayed in all patients with PVL IV. Thinning of the corpus callosum and presence of cortical atrophy were also correlated with neurological outcome. Significant risk factors associated with developmental delay were asphyxia at birth (odds ratio [OR] 4.3), PVL localization numbers over 3 (OR 4.4), PVL III to IV (OR 15), thinning of corpus callosum, and cortical atrophy.

Correlative value of magnetic resonance imaging for neurodevelopmental outcome in periventricular leukomalacia

The aim of this study was to evaluate the correlative value of magnetic resonance imaging (MRI) in children with periventricular leukomalacia (PVL) for neurodevelopmental outcome. MRI examinations of 89 children (46 males, 43 females) with PVL (median age 4y, range 1 to 14y) were reevaluated. PVL was graded as follows: grade I, unilateral or bilateral areas of periventricular hyperintensity (1-3); grade II, hyperintensity more than 3; grade III, hyperintense lesions more than 3 and ventricular wall irregularity; grade IV, diffuse PVL and ventricular dilatation. Localizations of PVL and brain abnormalities associated with PVL were also noted. Assignment to PVL grades on MRI was as follows: PVL I (n=22), PVL II (n=18), PVL III (n=30), and PVL IV (n=19). Cerebral palsy was slightly less common in children with PVL I and II compared with PVL III to IV. Motor function was normal in 50% of children with PVL grade I, but severely impaired in 73.7% of children with PVL grade IV. Results of visual function were normal in all with PVL I, but pathological in 42.1% of patients with PVL IV. Developmental tests were appropriate for age in 75% of patients with PVL I, but significantly delayed in all patients with PVL IV. Thinning of the corpus callosum and presence of cortical atrophy were also correlated with neurological outcome. Significant risk factors associated with developmental delay were asphyxia at birth (odds ratio [OR] 4.3), PVL localization numbers over 3 (OR 4.4), PVL III to IV (OR 15), thinning of corpus callosum, and cortical atrophy.

221 Neonatal Cranial Ultrasound Compared with Conventional MRI at School Age in Preterm Born Children, Related to Neurodevelopmental Outcome

Background: Cranial ultrasound (US) is the method of first choice to detect brain injury in preterm born infants. Recently Magnetic Resonance Imaging (MRI) has become available. Correlation between US and MRI is excellent for haemorrhages but poor for subtle white matter injury.Aim: To compare neonatal cranial US with MRI at school age, both related to outcome.Patients and methods: 221 (78.1%) out of 283 eligible children (GA< 32 weeks (mean 29.4 wks) and/or BW < 1500 grams (mean 1197 gr)) had a neonatal cranial US and an MRI at school age. Neonatal US findings were classified into group 1 (normal US), group 2 (Intraventricular Haemorrhage (IVH) grade 1/2, periventricular leukomalacia (PVL) grade 1, germinal layer necrosis) and group 3 (IVH grade 3/4, cystic PVL grade 2/3, thalamic lesions, focal infarction). MRIs were classified into group 1 (normal MRI ), group 2 (mild gliosis i.e. less than 5 small (2mm) areas of hyperintensity, mild ventricular dilatation (VD), thinning of corpus callosum) and group 3 (extensive gliosis, marked VD, thalamic lesions, cerebellar or cortical atrophy). IQ was estimated by 5 subtests of the WISC-R and motor function was assessed with the Movement ABC.Results: Of the 96 children in US group 1: 45 (47%) were in MRI group 1, 50 (52%) in MRI group 2 and 1 (1%) was in MRI group 3. Of the 90 children with a mildly abnormal US (group 2): 40 (44%) were in MRI group 1, 46 (51%) in MRI group 2 and 4 (4%) in MRI group 3. Of the 35 children with severe US abnormalities (group 3): 2 (6%) had a normal MRI, 8 (23%) were in MRI group 2 and 25 (71%) had a severely abnormal MRI (group 3). The predictive value of a normal US for a normal or mildly abnormal MRI was 99% (95% CI: 94–100%). The predictive value of a severely abnormal US for a severely abnormal MRI was 71% (95% CI: 54–85%). Mean IQ in US group 1 was not different from mean IQ in US group 2 (p=0.34), but higher than in US group 3 (p=0.02). Mean IQ in MRI group 1 was higher than in MRI group 2 (p=0.026) and in MRI group 3 (p=0.0001). Median Movement ABC scores in US group 1 were similar compared with US group 2 (p=0.59) but better compared with US group 3 (p=0.0001). For MRI median Movement ABC scores were better in MRI group 1 compared with MRI group 2 and MRI group 3 (p=0.0001 each).Conclusions: A normal cranial US almost guaranteed a normal or mildly abnormal MRI. MRI subgroups differentiated better for neurodevelopmental outcome than US subgroups.

Peri- and intraventricular cerebral sonography in second- and third-trimester high-risk fetuses: a comparison with neonatal ultrasound and relation to neurological development.

To determine whether periventricular leukomalacia (PVL) and peri- and intraventricular hemorrhages can be detected in fetuses at risk for preterm birth and to establish the clinical significance of this finding. Prenatal cerebral sonography was performed in 26 fetuses at risk for uteroplacental insufficiency on the day of inclusion into the study and weekly until delivery. Neonatal cerebral ultrasound examination was performed within 24 h of birth and biweekly until discharge. The infants underwent standardized neurological examinations. During 30 observations, 21/26 fetuses presented in a cephalic position. Successful visualization in the coronal and sagittal planes was significantly correlated with that of a control population (r = 0.615; 95% CI, 0.390-0.771). In 20/21 fetuses at least one observation was adequate for analysis. Eleven cerebral abnormalities were found in nine fetuses, periventricular echodensities in four, intraventricular hemorrhage in two, and localized thalamic densities in five. In six of these infants ultrasound abnormalities persisted after birth. Neurological follow-up at 24 months demonstrated abnormalities in three infants, two infants were normal and one was lost to follow-up. The three infants with normal ultrasound results after birth had a normal follow-up. Five infants with normal antenatal ultrasound results showed ultrasound abnormalities during the neonatal period; four of them developed PVL Grade 1 and one developed PVL Grade 2. The follow-up of two of these infants was normal, two died and one developed spastic tetraplegia. Abnormal antenatal brain sonography was significantly correlated with gestational age at birth (r = 0.487; P = 0.029). Peri- and intraventricular echodensities can be detected reliably before birth in fetuses at high risk for uteroplacental insufficiency. When abnormalities persist, there is a high risk for an adverse outcome.