objective in this study is to determine risk factors for periventricular white matter injury (PWMI), which accounts for 90% of the neurologic deficits, including cerebral palsy, cognitive, behavioral and attention deficits, that occur in surviving premature neonates. STUDY DESIGN: This is a cohort study of all VLBW neonates admitted to our NICU from April 2009 to April 2014 comparing those that developed PWMI on neonatal head ultrasound to those that did not. Neonates with chromosomal or major congenital abnormalities were excluded. Continuous variables were compared using an independent samples t-test and categorical variables using chi square. Variables with P<0.10 on bivariate analysis were compared using logistic regression. RESULTS: During this 5 year period there were 317 VLBW neonates admitted to our NICU of which 31 had PWMI. Of the 31 neonates with PWMI, 5 did not have a cord gas at birth and 22 had pH>7.20. Neonates with PWMI had a significantly lower gestational age at birth and had an increased incidence of IUGR, IVH, seizures and culture positive CSF infection. Cord pH, base deficit, and incidence of metabolic acidosis were not significantly different between groups. Logistic regression showed a significant increase in PWMI in the presence of culture positive CSF infection, but not metabolic acidosis (Table). CONCLUSION: In VLBW neonates, culture positive cerebrospinal fluid infection is an independent risk factor for PWMI as opposed to metabolic acidosis. This shows that CSF infection plays a larger role in neurologic injury in VLBW neonates than metabolic acidosis.
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