Transient Periventricular Echodensities Research Articles

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.

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.

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.

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.

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.

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.

Transient Periventricular Echodensities in Preterms and Neurodevelopmental Outcome

Little is known about the clinical evolution and neurologic sequelae of transient periventricular echodensities in the neonatal period. The aim of our study was to assess the neurodevelopmental outcome in preterm infants with transient periventricular echodensities. Cerebral ultrasonography was performed within the first 72 hours of life on all preterms with a < or = 37 weeks' gestational age who were admitted consecutively to the Neonatal Intensive Care Unit of the University of Parma from January 2001 to December 2002. Cerebral ultrasonography was performed at least twice within the 14th postnatal day and was repeated weekly until 40 weeks' postconceptional age. Transient aspecific echodensities were defined as areas in the periventricular region brighter than the choroid plexus persisting less than 14 days. One hundred sixty-four preterm infants were selected and divided into three groups: (1) 78 preterm infants without ultrasound abnormalities, (2) 50 preterm infants with transient periventricular echodensities, and (3) 36 preterm infants with persistent echodensities. Developmental outcome was assessed at 44 weeks' postconceptional age, after 1 month from the discharge and at the corrected ages of 3, 6, 9, and 12 months using the Griffiths Mental Developmental Scale. Group 1 and 2 infants showed normal neurodevelopment in 88.5% and 94% of cases, respectively, whereas the preterm infants belonging to group 3 had a favorable outcome in 22.2% (P < .001) of cases only. In conclusion, our study demonstrates how infants with transient echodensities show a neurodevelopmental outcome that is entirely identical to infants with a steadily negative ultrasound finding.

Ultrasonography of the peri‐ and intraventricular areas of the fetal brain between 26 and 36 weeks' gestational age; a comparison with neonatal ultrasound

To determine to what extent the peri- and intraventricular areas of the fetal brain can be visualized in coronal and sagittal planes using high-frequency transvaginal ultrasound. In a longitudinal study, fetuses of 30 low-risk pregnancies were studied at 26, 28, 30, 32, 34 and 36 weeks' gestational age. The neonates were examined within the first week of life. Visualization of the peri- and intraventricular areas was systematically scored in six coronal and five sagittal planes. The degree of echogenicity of the periventricular area was assessed. Inter- and intra-observer agreements were calculated. For fetuses in the cephalic position, the highest percentages of visualization of the planes were obtained between 26 and 32 weeks' gestational age (> 70% in four coronal and three sagittal planes). Transient periventricular echodensities were observed at 26 and 28 weeks' gestational age in 6/39 observations in the cephalic position. Small choroid plexus cysts were found in three fetuses with the changes persisting in two until after birth. Seven neonates developed mild periventricular echodensities/translucencies not present during fetal development. The mean interobserver agreement was 0.77 (95% confidence interval (CI) 0.73-0.81). The intra-observer agreement varied between 0.48 and 0.72 (mean 0.6, 95% CI 0.47-0.75). Transvaginal ultrasonography can be applied as a diagnostic tool to evaluate the peri- and intraventricular areas of the fetal brain. Transient periventricular densities can be encountered between 26 and 28 weeks. Term low-risk neonates may develop transient periventricular densities or translucencies.

Relation between visual perceptual impairment and neonatal ultrasound diagnosis of haemorrhagic‐ischaemic brain lesions in 5‐year‐old children

Visual‐perceptual abilities were assessed in 5‐year‐old children with the following neonatal neurological conditions: born preterm with normal ultrasound scan (NL, n=17); born preterm with ultrasound diagnosis of intraventricular haemorrhage (IVH, n=17); born preterm with ultrasound diagnosis of periventricular leukomalacia (PVL, n=12); born term with hypoxic‐ischaemic encephalopathy (HIE, n=11). Visual‐perceptual ability was evaluated with the L94: eight visual‐perceptual tasks designed to evaluate different aspects of visual perception at the preschool level in children with multiple disabilities. Impairment was established in comparison to the performance age obtained on non‐verbal intelligence subtests, instead of chronological age. Frequency of L94 impairment was highest in children with PVL, while children with IVH did not differ from the NL control group. Impairment rates were increased also in children with transient periventricular echodensities, and in children with HIE. Impairments were only moderately related to the delay of visual acuity maturation in infancy.

Transient periventricular echodensities and developmental outcome in preterm infants

The outcome of very low–birth-weight infants is reported in relation to neonatal cerebral ultrasound findings. Routine cerebral ultrasound scans were performed in all 147 very low–birth-weight infants admitted to the authors’ neonatal intensive care unit from January 1995 to June 1997. Group 1 consisted of 22 infants without ultrasound abnormalities, group 2 consisted of 32 infants with transient periventricular echodensities, and group 3 consisted of 15 infants with intraventricular hemorrhage. Neurologic status was recorded at follow-up visits at the corrected age of 6 and 12 months, and the infants were evaluated further using the Bayley Scales of Infant Development II. More infants in groups 2 and 3 appeared to have significant and mild motor developmental delays than infants in the control group (group 1) at the corrected age of 1 year ( P = 0.001). Furthermore, more infants in group 3 appeared to have significant motor developmental delays than did infants in group 2 at the corrected age of 1 year (15% vs 3%). Infants with transient periventricular echodensities and intraventricular hemorrhage have an increased risk of delayed developmental outcome. Infants with transient periventricular echodensities have a more favorable prognosis than do the infants with intraventricular hemorrhage.

Characteristics of cranial ultrasound white‐matter echolucencies that predict disability: a review

Characteristics of cranial ultrasound white‐matter echolucencies that predict disability: a review

Developmental implications of head growth following intracranial hemorrhage.

This study examined the association between head size at birth, discharge, and 1 year and developmental outcome at 1 year in preterm infants, with and without intracranial hemorrhages (ICH) or associated periventricular echodensities (PVE). The data indicated that most sick preterm infants with small heads at discharge achieved appropriate head sizes at 1 year. Analyses of the 1-year mental and motor performances of 125 subjects revealed that for subjects who did not develop ICH, appropriate head sizes at birth and discharge were associated with good developmental outcome, whereas infants with small heads (< two standard deviations below the mean for age) before hospital discharge were more likely to show poorer developmental outcome at 1 year. For subjects with ICH, birth and discharge head circumference were not predictive of 1-year developmental status; however, normal head size at 1 year was associated with better outcome. This was true for children with transient PVE as well. However, persistent periventricular echodensities were associated with both mental and motor deficits at 1 year, regardless of head growth.

Risk Factors for Transient Periventricular Echodensities in Very-Low-Birth-Weight Infants † 1231

Sonographically detectable transient periventricular echodensities (PVED) are often observed in very-low-birth-weight (VLBW, <1500 gm) infants when screening for intraventricular hemorrhage (IVH); their impact on outcome remains unclear but recent studies have suggested an adverse neurodevelomental influence. Although hypoxia-ischemia has been considered a possible cause, clinically relevant risk factors and preventive treatments for this finding remain uncertain. We performed a retrospective matched case-control study of PVED and risk factors in all infants <1500 gm BW from 6/90-12/95, during which sonographic screening was routine. We studied antepartum, intrapartum, and postnatal factors, concentrating on epidemiologic, vascular, respiratory, and infectious factors, and on intrapartum magnesium sulfate (MAG) exposure, because of recent suggestions of a neuro-protective effect of this agent. We identified 1417 VLBW infants and 74 cases of transient PVED (inc. 5.2%) and matched 74 controls with normal sonograms (no IVH or PVL, latest at least 30d) for ±150 gm BW and date of birth. Controls and cases were similar in BW(994±242 vs 981±238 gm) and gestational age (28±2 wks). PVED cases were more likely to have placental funisitis (32%vs 3%) and patent ductus arteriosus (59% vs 38%) and less likely to have pre-eclampsia (4% vs 21%)(all P≤0.05). The proportions of any intrapartum MAG, tocolytic MAG, steroid use, SGA, RDS, and indomethacin were similar between groups. A logistic regression model (controlled for MAG use, chorioamnionitis, and indomethacin use) revealed predictors of PVED as shown in the Table. We conclude that intrapartum infection and PDA are risk factors for PVED in VLBW infants and that pre-eclampsia is more important than MAG use in reducing such neurologic findings.

Quality of general movements in preterm infants with transient periventricular echodensities

By means of sequential videotape recordings, the relevance of the quality of general movements for neurological outcome was determined in a group of 21 appropriate‐for‐gestational‐age preterm infants with transient periventricular echodensities of variable localization and duration and in 6 infants without echodensities. Echodensities, especially in the parieto‐occipital area, affected the quality of general movements. Echodensities persisting beyond 14 d were associated with abnormal general movements; infants with echodensities up to 14 d had either normal or abnormal general movements. The developmental course of movement quality was correlated to neurological outcome (p &lt; 0:005): normal outcomes were found in 11/12 infants with normal general movements throughout and in 9/11 infants with transient abnormal general movements; all 4 infants with persistent abnormal general movements had impaired outcomes. In infants with transient echodensities, longitudinal assessment of the quality of general movements helps to determine if there is brain dysfunction, either transient or persistent, and identifies infants at risk for impaired neurological outcomes.

Quality of general movements in preterm infants with transient periventricular echodensities: a commentary

Quality of general movements in preterm infants with transient periventricular echodensities: a commentary

Quality of general movements in preterm infants with transient periventricular echodensities: a commentary.

Quality of general movements in preterm infants with transient periventricular echodensities: a commentary.

Outcome of Transient Periventricular Echodensities in Preterm Infants

In this prospective study routine ultrasound scanning of the brain was performed in all 353 infants of less than 32 weeks of gestation who had been admitted to our neonatal intensive care unit from 1987-1990. Ten infants (2.8%) showed transient periventricular echodensities (TPE) without the subsequent development of cysts and/or ventricular dilation. Nineteen infants (5.4%) developed periventricular leukomalacia (PVL). At the corrected age of 2 years the neurodevelopmental outcome was assessed. Five children with PVL had died before the age of 2 years. The neurodevelopmental outcome of children with TPE and PVL was compared with the outcome of 21 preterm children matched for gestational age, birth weight and severity of illness, and without ultrasound abnormalities of the brain in the neonatal period, who had also been admitted to our neonatal intensive care unit during the study period. Children with TPE and PVL appeared to have more handicaps than the control children. The children with TPE had significantly more minor motor handicaps than the control children, while the children with PVL had more major handicaps of all origins. Although infants with TPE had a more favorable prognosis than infants with PVL they should not be disregarded because TPE appear to be of clinical importance.