Neurodevelopmental outcomes of children with periventricular leukomalacia: the role of infection and ischemia

Abstract

Introduction: Periventricular leukomalacia (PVL) is an important cause of preterm newborn’s cerebral white matter disease. This study assessed neurodevelopmental outcomes of children with PVL and its etiologic subgroups. Methods: Retrospective review of medical records of children with PVL diagnosis born at a tertiary center between 1996 and 2016. Subjects were divided into two groups according to the most likely etiology of PVL (ischemic versus infectious) using a classification system of risk factors. The neurologic and development outcomes were reviewed. Results: A total of 34 newborns with a median gestational age of 29 weeks were selected. Sixteen newborns (51.6%) were included in the ischemic group, while 15 (48.4%) were included in the infectious group; a clear group classification was not possible in 3 cases. PVL was moderate to severe in 73.5% of cases. Cerebral palsy (CP) developed in 69.7% of the children, 29% had epilepsy and 15.6% were microcephalic. Children with moderate to severe PVL were significantly more impaired than children with mild PVL (p < 0.05). Moderate to severe PVL was observed in 93.3% of the children in the infectious group and 71.4% in the ischemic group (p = 0.12). Children in the infectious group were more prone to abnormal development and CP, while children in the ischemic group had more epilepsy and hearing impairment than the infectious group. Discussion: Infection may be an important etiologic factor regarding severe forms of PVL. The infectious group presented a higher incidence of CP, which may be related to more severe white matter injuries. The ischemic group presented more epilepsy, suggesting the involvement of gray matter disease.

Keywords

• periventricular leukomalacia
• etiology
• cerebral palsy
• neonatal brain white matter injury
• cognitive outcome