title: Ultrasonographic features and severity scoring of periventricular hemorrhagic infarction in relation to risk factors and outcome.
abstract: OBJECTIVE
  Early diagnosis of periventricular hemorrhagic infarction in premature infants is based on bedside neonatal cranial ultrasonography. Currently, evaluation of its morphology and evolution by cranial ultrasound relies largely on data predating major advances in perinatal care and lacks a consistent classification system for determining severity of injury. The objective of this study was to examine the ultrasonographic morphology and evolution of periventricular hemorrhagic infarction in the modern NICU and to determine the value of a cranial ultrasonography-based severity score for predicting outcome.
  
  
  METHODS
  We retrospectively evaluated all cranial ultrasounds and medical records of 58 premature infants with periventricular hemorrhagic infarction. We assigned each subject a severity score based on extent of echodensity, unilateral versus bilateral, and presence or absence of midline shift. A neurologic examination was performed after 12 months adjusted age.
  
  
  RESULTS
  The parenchymal echodensity of periventricular hemorrhagic infarction most often involved parietal and frontal territories and evolved into single and/or multiple cysts. One quarter of cases were bilateral, and nearly 70% were extensive. Higher severity scores were significantly associated with pulmonary hemorrhage and low bicarbonate levels and with outcomes of fatality, early neonatal seizures, and motor disability.
  
  
  CONCLUSIONS
  Despite advances in perinatal medicine, periventricular hemorrhagic infarction remains an important complication of prematurity. Periventricular hemorrhagic infarction can be graded using a scoring system based on sonographic characteristics. Higher severity scores predict worse outcome. Such severity scoring could improve the clinician's ability to counsel parents regarding management decisions and early intervention strategies.
authors.affiliation: Fetal/Neonatal Neurology Research Group, Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Haim
authors.initials: H
authors.lastname: Bassan
authors.forename: Carol B
authors.initials: CB
authors.lastname: Benson
authors.forename: Catherine
authors.initials: C
authors.lastname: Limperopoulos
authors.forename: Henry A
authors.initials: HA
authors.lastname: Feldman
authors.forename: Steven A
authors.initials: SA
authors.lastname: Ringer
authors.forename: Elaine
authors.initials: E
authors.lastname: Veracruz
authors.forename: Jane E
authors.initials: JE
authors.lastname: Stewart
authors.forename: Janet S
authors.initials: JS
authors.lastname: Soul
authors.forename: Donald N
authors.initials: DN
authors.lastname: Disalvo
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Volpe
authors.forename: Adré J
authors.initials: AJ
authors.lastname: du Plessis
mesh_terms: D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging*; D002552:Cerebral Ventricles; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014463:Ultrasonography