title: Periventricular leukomalacia with late-onset circulatory dysfunction of premature infants: correlation with severity of magnetic resonance imaging findings and neurological outcomes.
abstract: The incidence of late-onset circulatory dysfunction (LCD) of premature infants, which is characterized by sudden hypotension and oliguria, has recently increased in Japan. This condition suddenly occurs after several days of age without obvious causes in preterm infants with stable respiration and circulation. Intravenous steroids frequently improve the hypotension. The main problem with LCD is the subsequent and frequent onset of periventricular leukomalacia (PVL), and neurological development appears to be worse in PVL patients with LCD than those without LCD. The aim of this study was to determine whether the severity of magnetic resonance imaging (MRI) findings and neurological outcomes differ between infants who developed PVL after LCD and those who developed PVL without LCD. We retrospectively studied preterm infants who were delivered at less than 33 weeks of gestation between the years 2000 and 2003. During the study period, 10 and 26 infants developed PVL with and without LCD, respectively. The incidence of severe or moderate MRI findings was significantly higher in PVL patients with LCD (100%) than those without LCD (50%; p < 0.05). The incidence of severe cerebral palsy was 88% in PVL infants with LCD and 43% in PVL infants without LCD (p < 0.05). Moreover, the incidence of visual disorders was significantly higher in PVL infants with LCD (63%) than those without LCD (9%; p < 0.01). In conclusion, neurological outcomes are worse in preterm infants who develop PVL with LCD than those without LCD, which is well correlated to the severity judged by MRI findings.
authors.affiliation: Department of Pediatrics, Neonatology and Congenital Disorders, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. skoba@med.nagoya-cu.ac.jp
authors.forename: Satoru
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Shinji
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Sumio
authors.initials: S
authors.lastname: Fukuda
authors.forename: Ayako
authors.initials: A
authors.lastname: Hattori
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Iwaki
authors.forename: Norihisa
authors.initials: N
authors.lastname: Koyama
authors.forename: Taihei
authors.initials: T
authors.lastname: Tanaka
authors.forename: Minoru
authors.initials: M
authors.lastname: Kokubo
authors.forename: Tohru
authors.initials: T
authors.lastname: Okanishi
authors.forename: Hajime
authors.initials: H
authors.lastname: Togari
mesh_terms: D001775:Blood Circulation / Q000502:physiology*; D002547:Cerebral Palsy / Q000209:etiology*; D018450:Disease Progression; D004827:Epilepsy / Q000209:etiology; D005260:Female; D005865:Gestational Age; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000150:complications; D020925:Hypoxia-Ischemia, Brain / Q000150:complications*; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007969:Leukomalacia, Periventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009846:Oliguria / Q000150:complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014463:Ultrasonography; D014652:Vascular Diseases / Q000150:complications; D014786:Vision Disorders / Q000209:etiology