Periventricular-intraventricular hemorrhage, sonographic localization, phenobarbital, and motor abnormalities in low birth weight infants.
A total of 228 low birth weight (less than 1750 g), mechanically ventilated infants with and without periventricular-intraventricular hemorrhage were examined at 18 months corrected age to assess the relationship between cranial ultrasonographic findings and specific motor abnormalities. All infants were previously enrolled in a double-blind, randomized, prospective clinical trial of phenobarbital prophylaxis against periventricular-intraventricular hemorrhage. Ultrasonographic abnormalities on the scans performed between 7 and 13 days of life were categorized as germinal matrix hemorrhage, lateral ventricular hemorrhage, parenchymal hemorrhage, ventriculomegaly, and any hemorrhage. Regardless of anatomical location, periventricular-intraventricular hemorrhage was associated with an increased risk for developing motor abnormalities. Hypertonia and hyperreflexia/ankle clonus were most common. No abnormal motor findings distinguished unilateral from bilateral germinal matrix hemorrhage and lateral ventricular hemorrhage or between phenobarbital and placebo treatment. None of the 5 infants with parenchymal hemorrhage had spastic cerebral palsy. Ventriculomegaly was associated with a fivefold increase in risk for spastic cerebral palsy and delayed walking and a threefold increase for hypertonia and hyperreflexia/clonus. The results suggest that ventriculomegaly, observed even as early as the first week of life, might be a significant antecedent of later motor abnormalities among the survivors of periventricular-intraventricular hemorrhage.
Krishnamoorthy
K S
KS
Department of Neurology, Massachusetts General Hospital, Boston 02114.
Kuban
K C
KC
Leviton
A
A
Brown
E R
ER
Sullivan
K F
KF
Allred
E N
EN
D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control; D002552:Cerebral Ventricles / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D009460:Neurologic Examination; D010634:Phenobarbital / Q000627:therapeutic use*; D011596:Psychomotor Disorders / Q000175:diagnosis* / Q000209:etiology; D012021:Reflex, Abnormal; D014463:Ultrasonography
D010634:Phenobarbital