Late-Onset Cystic Periventricular Leukomalacia in Premature Infants: A Threat Until Term

Abstract

The purposes of this study are (1) to describe a "late-onset" form of cystic periventricular leukomalacia eventually appearing in premature infants whose neurological assessments were normal in the first month of life; (2) to retrospectively evaluate its incidence among a large population of premature infants; (3) to suggest that a few unexpected complications of prematurity may trigger the development of white matter damage, even several weeks after birth. Retrospective study in a population of 1452 surviving infants after 5 days born before 33 weeks. We identified 10 cases of late-onset cystic periventricular leukomalacia appearing beyond the first 5 weeks of life. In 8 cases, an intercurrent event associated with a systemic inflammatory response preceded the appearance of cysts: necrotizing enterocolitis (n = 5), septicemia (n = 2 cases), strangulated inguinal hernia in one infant. Neurological surveillance should be repeated until discharge in very preterm infants, especially after the occurrence of an intercurrent complication coming along with a systemic inflammatory response.

Serial Head Ultrasound Studies in Preterm Infants: How Many Normal Studies Does One Infant Need to Exclude Significant Abnormalities?

“…As in our study, such critically ill babies clearly deserve repeat scans. Goetz et al, 36 similar to the study of Andre et al 14 and to our study, noted that infants who had initial normal HUS and developed late cystic PVL were of shortest GA and lowest BW. Goetz et al recommended different schedules of HUS screening based on BW.…”

“…1 A total of 520 neonates r32 weeks in GA were admitted over the 2 1 2 years study period ( Figure 1) F overall, 41 had no HUS (16 died before a scan was done), 379 had normal (or only minor abnormality) studies, and 100 (21% of all those scanned) had major HUS abnormalities detected (Table 1), comparable to previous reports. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] We excluded from further analysis the 41 babies having no HUS study, the 198 having only one study, and 40 infants who had two studies, but less than 7 days apart (the 20 normal infants from this group had no repeat scans). Of the remaining 241 infants who had two or more scans, with the first two Z7 days apart, 43 were abnormal on the first or second study, with six of these reverting to normal on a third scan.…”

“…13 Thus cystic PVL is usually detected on HUS after the first 2 to 3 weeks of life. 14,15 Nonobstructive VM detected by a HUS study may be a manifestation of early diffuse white matter injury not associated with IVH or initial periventricular echogenicity (PVE). 16 Previous studies have demonstrated that severe IVH, VM and PVL can be clinically occult.…”

Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants

“…Late detection of periventricular cysts was related to ''late onset c-PVL'' in 5 infants, demonstrating the need for sequential scans after an acute deterioration. 24,25 Extensive c-PVL (grade III) was first detected at 40 weeks, without the presence of severe periventricular echogenicities at an earlier stage, in 4 infants. Eight of the remaining 10 infants who developed cysts beyond the first 4 weeks after birth were all infants who took a long time to develop localized c-PVL (grade II).…”

Comment décider avec justesse, justice et équité? Réflexion sur la décision en situation d'extrême prématurité

“…Ainsi, les lésions secondaires à une hypoxie anténatale ou perpartale seront visibles sur une ETF de façon précoce, alors que celles de constitution postnatale, liées à la grande prématurité ou à des évènements intercurrents seront visibles plus tardivement. Pour cette raison, il est important de répéter les examens [20,21]. Les lésions sont appré-ciées en fonction de leur caractère étendu et notamment bilatéral, de leur type, de leur localisation et de leur évo-lution.…”