Relationship between periventricular intraparenchymal echodensities and germinal matrix-intraventricular hemorrhage in the very low birth weight neonate.
The pathogenesis of the periventricular intraparenchymal echodense lesion (IPE) observed in association with germinal matrix-intraventricular hemorrhage (GM-IVH) in premature neonates is unclear. The objectives of this study were to determine (1) the temporal characteristics of GM-IVH and IPE, (2) the basic characteristics of the IPE, and (3) the relationship of clinical events, including surfactant administration, to IPE. One hundred twenty-four neonates of less than 1250 g birth weight were prospectively evaluated. IPE was defined as an echodensity greater than 1 cm in diameter by cranial sonography. Fifteen (12%) neonates developed IPE in association with GM-IVH (group 1); 33 neonates developed GM-IVH only (group 2) and 76 neonates without GM-IVH served as comparison group (group 3). IPE was essentially an asymmetrical lesion; both sides of cerebrum were equally affected. The lesion was diffuse in 9 neonates and focal in 5. IPE occurred both early, at 36 hours or before (n = 8), and later, ie, between 48 and 96 hours (n = 6). In one neonate IPE was diagnosed at autopsy. GM-IVH and IPE were noted simultaneously in neonate with the earlier onset IPE (diagnosed within 36 hours); GM-IVH preceded the IPE by 6 to 48 hours when the lesion was of a later onset. Surfactant was administered to 13 (87%) group 1, 24 (73%) group 2, and 35 (46%) group 3 neonates. Pulmonary hemorrhage developed in 9 (60%) of group 1, 3 (9%) group 2, and no group 3 neonates. Symptomatic patent ductus arteriosus occurred in 12 (75%) group 1, 15 (45%) group 2, and 15 (20%) group 3 neonates. The onset of symptoms associated with patent ductus arteriosus was earlier in group 1 vs group 2 or group 3 neonates, ie, 70 vs 172 hours. Nine (60%) group 1 neonates, 6 (18%) group 2, and 5 (7%) group 3 neonates died. The cranial sonogram was markedly abnormal in all 6 group 1 survivors. Stepwise polytomous logistic regression indicated that birth weight, gestational age, and emergent cesarean section were the best predictors of GM-IVH + IPE.(ABSTRACT TRUNCATED AT 250 WORDS)
Perlman
J M
JM
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063.
Rollins
N
N
Burns
D
D
Risser
R
R
D001034:Apgar Score; D001344:Autopsy; D001724:Birth Weight; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D002552:Cerebral Ventricles; D002585:Cesarean Section / Q000706:statistics & numerical data; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000453:epidemiology; D005865:Gestational Age; D006470:Hemorrhage / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007969:Leukomalacia, Periventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D016015:Logistic Models; D008171:Lung Diseases / Q000150:complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D014463:Ultrasonography
D011663:Pulmonary Surfactants