title: Persistent periventricular echogenicities in preterms are not related to smaller brains at term-equivalent age.
abstract: BACKGROUND
  Periventricular white matter (PWM) is particularly vulnerable in very preterm infants. Non-cystic white matter injury, known as non-cystic periventricular leukomalacia (ncPVL), is the commonest 'lesion' affecting the preterm brain. There is no consensus about whether ncPVL can be reliably identified from cerebral ultrasound (cUS) or whether there is any reliable correlate of ncPVL on cUS at term-equivalent age (TEA).
  
  
  OBJECTIVE
  To compare brain volumes and linear measures at TEA in infants with and without a diagnosis of ncPVL.
  
  
  METHODS
  Preterm infants of ≤32 weeks' gestation without major lesions were serially assessed using cUS. ncPVL was defined as PWM echogenicity comparable to the choroid plexus on two scans at least 2 weeks apart after the first postnatal week. At TEA, infants were scanned for the estimation of brain volume and ventricular and tissue dimensions. Head circumference was measured. The data were compared between those with/without ncPVL. Observer agreement was assessed using kappa statistic.
  
  
  RESULTS
  Of 63 eligible infants 29% had ncPVL. Significant differences were found between those with/without ncPVL for 5 min Apgar score, CRIB score, invasive ventilation rates and chronic lung disease but not for other relevant clinical data. No significant differences were found for estimated brain volume, ventricular size, corpus callosum length/thickness or central grey matter width. Intra-observer reliability was moderate (kappa = 0.51-0.56); inter-observer reliability was poor (kappa = 0.20-0.32).
  
  
  CONCLUSIONS
  This study indicates that an ultrasound diagnosis of ncPVL should not be used as a sole predictor of lower brain growth detectable at TEA.
authors.affiliation: Neonatal Intensive Care Unit, Department of Paediatrics, Lisbon Academic Medical Center, Lisbon, Portugal.
authors.forename: André M
authors.initials: AM
authors.lastname: Graça
authors.forename: Katia
authors.initials: K
authors.lastname: Cardoso
authors.forename: João
authors.initials: J
authors.lastname: Costa
authors.forename: Frances
authors.initials: F
authors.lastname: Cowan
mesh_terms: D001921:Brain / Q000033:anatomy & histology / Q000473:pathology*; D015331:Cohort Studies; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging / Q000473:pathology*; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D014463:Ultrasonography