Background-Neurosonography can assist clinicians and can provide researchers with documentation of brain lesions. Unfortunately, we know little about the reliability of sonographically derived diagnoses.
The purpose of this article is to investigate the hyperechoic lesion seen adjacent to a lateral ventricle that contains blood but is not distended. The literature on ependymal barrier dysfunction was reviewed in search of mechanisms of injury to the white matter adjacent to an intraventricular hemorrhage. The clinical literature on the clinical diagnosis of periventricular hemorrhagic infarction was also reviewed to find out how frequently this diagnosis was made. Support was found for the possibility that the ventricular wall does not always function as an efficient barrier, allowing ventricular contents to gain access to the white matter where they cause damage. Hemorrhagic infarction may not be the only or the most frequent mechanism of white matter damage adjacent to a large intraventricular hemorrhage.
Objective To examine the extent to which weight gain and weight status in the first 2 years of life relate to the risk of neurodevelopmental impairment in extremely preterm infants. Study Design In a cohort of 1070 infants born between 23 and 27 weeks’ gestation, we examined weight gain from 7-28 days of life (in quartiles) and weight z-score at 12 and 24 months corrected age (in categories: <−2; ≥−2, <−1; ≥1, <1; ≥1) in relation to these adverse neurodevelopmental outcomes: Bayley-II mental development index <55, Bayley-II psychomotor development index <55, cerebral palsy, Gross Motor Function Classification System (GMFCS) ≥1 (cannot walk without assistance), microcephaly. We adjusted for confounders in logistic regression, stratified by sex, and performed separate analyses including the entire sample, and excluding children unable to walk without assistance (motor impairment). Results Weight gain in the lowest quartile from 7-28 days was not associated with higher risk of adverse outcomes. Children with a 12-month weight z-score <−2 were at increased risk for all adverse outcomes in girls, and for microcephaly and GMFCS ≥1 in boys. However, excluding children with motor impairment attenuated all associations except that of weight z-score <−2 with microcephaly in girls. Similarly, most associations of low weight z-score at 24 months with adverse outcomes were attenuated with exclusion of children with motor impairment. Conclusion Excluding children who have gross motor impairment appears to eliminate the association of low weight status with neurodevelopmental impairments at 2 years in extremely preterm infants.
Purpose-To evaluate reader variability of white matter lesions seen on cranial sonographic scans of extreme low gestational age neonates (ELGANs).Methods-In 1,452 ELGANs, cranial sonographic scans were obtained in the first and second postnatal weeks, and between the third postnatal week and term. All sets of scans were read independently by two sonologists. We reviewed the use of four diagnostic labels: early periventricular leucomalacia, cystic periventricular leucomalacia, periventricular hemorrhagic infarction (PVHI), and other white matter diagnosis, by 16 sonologists at 14 institutions. We evaluated the association of these labels with location and laterality of hyperechoic and hypoechoic lesions, location of intraventricular hemorrhage, and characteristics of ventricular enlargement.© 2010 Wiley Periodicals, Inc.Correspondence to: Sjirk Westra. Additional Supporting Information may be found in the online version of this article. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptResults-Experienced sonologists differed substantially in their application of the diagnostic labels. Three readers applied early periventricular leucomalacia to more than one fourth of all the scans they read, whereas eight applied this label to ≤5% of scans. Five applied PVHI to ≥10% of scans, while three applied this label to ≤5% of scans. More than one third of scans labeled cystic periventricular leucomalacia had unilateral hypoechoic lesions. White matter abnormalities in PVHI were more extensive than in periventricular leucomalacia and were more anteriorly located. Hypoechoic lesions on late scans tended to be in the same locations, regardless of the diagnostic label applied.Conclusions-Experienced sonologists differ considerably in their tendency to apply diagnostic labels for white matter lesions. This is due to lack of universally agreed-upon definitions. We recommend reducing this variability to improve the validity of large multicenter studies. Keywordsneurosonography; white matter lesions; prematurity; multicenter studies; diagnostic classifications Preterm infants are physiologically unstable in the first weeks of life; thus, bedside ultrasonography is the only feasible technique to monitor the appearance of the brain. Valuable confirmatory tests such as CT and (in particular) MRI are less easily obtained given the difficulty of transporting these patients outside of the neonatal unit. Performance and interpretation of cranial sonographic scans vary among even highly competent sonographers and sonologists. [1][2][3] To improve communication with referring physicians and to facilitate correlation with neurodevelopmental outcomes, various grading or severity scoring systems have been proposed. [4][5][6] Since the introduction of the Papile classification of intraventricular hemorrhage (IVH) in premature infants, 7 diagnostic criteria of IVH have been controversial. IVH and ipsilateral periventricular hyperechoic lesions, including periventricular hemorrhagic infarction (...
10-YEAR-OLD boy was seen for a 3-day history of right-sided abdominal pain, widespread cutaneous petechiae, and a 2-day history of fever (temperatures up to 39°C). A pertinent finding from medical history was a diagnosis of lymphoblastic lymphoma 2 1 ⁄2 years previously. He had a relapse 1 year previously with acute myeloblastic leukemia and underwent bone marrow transplantation 8 months previously. He had another relapse with acute myeloblastic lymphoma 1 month prior to this admission, and subsequently received chemotherapy 1 SPECIAL FEATURE
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