Trends in severe brain injury and neurodevelopmental outcome in premature newborn infants: the role of cystic periventricular leukomalacia.
OBJECTIVE
To determine if the incidence of sonographically detected cystic periventricular leukomalacia (PVL) and periventricular hemorrhagic infarction (PVHI) have changed over the past decade and to determine if a decline in cystic PVL was associated with a change in neurodevelopmental outcome.


METHODS
Premature newborn infants admitted to our intensive care nursery from 1992 to 2002 were identified in a comprehensive nursery database. Premature newborn infants had routine neurosonography by means of a standardized protocol. Infants weighing < or =1500 g at birth surviving to nursery discharge were enrolled in a nursery follow-up clinic.


RESULTS
Adjusting for gestational age, there was a significant decrease in cystic PVL from 1992 to 2002 (P=.003) without a concurrent decrease in PVHI (P=0.5). Cystic PVL and PVHI accounted for only 9 of the 28 cases of cerebral palsy and 12 of 90 cases of abnormal Developmental Scores in infants weighing <1500 g at birth. The decline in cystic PVL was not associated with improved developmental outcome from 1992 to 2002.


CONCLUSIONS
The incidence of cystic PVL declined significantly from 1992 to 2002 at our center. Cystic PVL was detected by ultrasound in a minority of infants with abnormal neurodevelopmental outcome, indicating that other forms of cerebral injury account for the majority of abnormal neurodevelopmental outcomes in premature newborn infants.
Hamrick
Shannon E G
SE
Department of Pediatrics, University of California San Francisco, CA 94143-0663, USA.
Miller
Steven P
SP
Leonard
Carol
C
Glidden
David V
DV
Goldstein
Ruth
R
Ramaswamy
Vijay
V
Piecuch
Robert
R
Ferriero
Donna M
DM
D001921:Brain / Q000254:growth & development / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002657:Child Development / Q000502:physiology*; D004453:Echoencephalography; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D009048:Motor Skills / Q000502:physiology