Preterm twin gestation and cystic periventricular leucomalacia.
OBJECTIVE
To identify risk factors for the development of cystic periventricular leucomalacia (PVL) in twin gestation.


METHODS
Retrospective case-control study.


METHODS
Tertiary care university hospital, Department of Paediatrics, Division of Neonatology, Graz, Austria.


METHODS
Preterm twin gestations with one sibling having developed cystic PVL, diagnosed by ultrasound scans, compared with their co-twins without PVL, in hospital between 1988 and 2000.


METHODS
Perinatal and postnatal risk factors for the development of PVL.


RESULTS
Eighteen preterm twin gestations were included. Monochorionicity was evident in 47% of the pregnancies, and twin to twin transfusion syndrome occurred in two cases (11%). Fetal distress correlated inversely with PVL (15% v 53%, p = 0.019, relative risk (RR) = 2.057, 95% confidence interval (CI) = 1.067 to 3.968). Hypocarbia with Pco(2) levels below 30 mm Hg (4 kPa) was diagnosed in 29% of the cases compared with 6% of the controls (p = 0.038, RR = 1.944, 95% CI = 1.113 to 3.396). There were no significant differences between groups with regard to premature rupture of the membranes, early onset infection, respiratory distress syndrome, mechanical ventilation, arterial hypotension, persistent ductus arteriosus, and hyperbilirubinaemia. Asphyxia was only evident in three controls. Three infants died and another three were lost to follow up. None of the cases compared with 62% of the controls were diagnosed as having developed normally (p < 0.001), and 14 cases (82%) compared with two controls (15%) developed cerebral palsy (p < 0.001).


CONCLUSIONS
Hypocarbia was the only risk factor strongly associated with cystic PVL. The general outcome of the infants was poor.
Resch
B
B
Department of Paediatrics, University Hospital Graz, Auenbruggerplatz 30, 8036 Graz, Austria. bernhard.resch@meduni-graz.at
Jammernegg
A
A
Vollaard
E
E
Maurer
U
U
Mueller
W D
WD
Pertl
B
B
D000328:Adult; D001724:Birth Weight; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging / Q000209:etiology*; D007752:Obstetric Labor, Premature / Q000209:etiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011272:Pregnancy, Multiple; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014427:Twins; D016216:Ultrasonography, Prenatal