Bilateral Cystic Periventricular Leukomalacia in the Premature Infant: Associated Risk Factors

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 822-827 ◽  
Author(s):  
Jeffrey M. Perlman ◽  
Rick Risser ◽  
R. Sue Broyles
Keyword(s):  
Positive Predictive Value ◽  
Premature Infant ◽  
Preterm Infants ◽  
Predictive Value ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia ◽  
Univariate Analysis ◽  
Cranial Ultrasound ◽  
Ultrasound Screening ◽  
Increased Risk

Background. Bilateral cystic periventricular leukomalacia (PVL) is a major cause of neurodevelopmental delay in the premature infant. Thus, early identification of the preterm infant at highest risk for the subsequent development of this lesion is critical. Objectives. The three objectives of this case-control study were: (1) to determine the basic characteristics of cystic PVL, (2) to assess the relationship of perinatal clinical events and PVL, and (3) to ascertain the feasibility of identifying early those preterm infants at highest risk for the development of PVL. Methods. The medical records and cranial ultrasound scans (HUSs) were reviewed for 632 infants weighing less than 1750 g who were admitted to the neonatal intensive care unit between January 1992 and December 1993. PVL developed in 14 infants of 1285 ± 301 g birth weight (BW) and 29.4 ± 1.5 weeks' gestational age (GA); severe intraventricular hemorrhage (n = 21) and intraparenchymal echodensity (n = 12) developed in 33 infants of 904 ± 248 g BW and 26.6 ± 1.8 weeks' GA; and 585 infants of 1315 ± 324 g BW and 29.7 ± 2.4 weeks' GA with normal HUS findings (n = 473) or grade I or II intraventricular hemorrhage (n = 112) served as a comparison group. Results. Cystic PVL was observed in 14 (2.3%) of 632 infants weighing less than 1750 g, more specifically, in 3.2% of infants weighing less than 1500 g. Cysts were noted from the 7th to 14th days of life in 10 infants and from the 20th to 46th days of life in 4 infants. Ten (70%) of the infants had relatively benign clinical courses, and most cases were detected by routine HUS surveillance. Overt hypotension in the immediate perinatal period was noted in 3 (21%) infants; late hypotension developed in 1 additional infant. Univariate analysis indicate that two clinical indicators, prolonged rupture of membranes (PROM) and chorioamnionitis, were significant predictors of PVL. For PROM, the odds ratio estimate and the 95% confidence limit are 6.59 and 1.96 to 22.10, with a sensitivity of 28.6% and positive predictive value of 11.5%. Similar values for chorioamnionitis are 6.77 (1.77 to 25.93), with a sensitivity of 21.4% and positive predictive value of 11.5%. Conclusions. (1) Most cases of symmetric cystic PVL occurred in infants with relatively benign clinical courses and were only detected by routine ultrasound screening. (2) Postnatal systemic hypotension seems to be an uncommon associated event. (3) Preterm infants born to mothers with PROM and/or chorioamnionitis seem to be at an increased risk for the development of PVL and should be carefully evaluated.

Value of Cranial Ultrasound and Magnetic Resonance Imaging in Predicting Neurodevelopmental Outcome in Preterm Infants

PEDIATRICS ◽  
1992 ◽  
Vol 90 (2) ◽  
pp. 196-199
Author(s):  
Margot van de Bor ◽  
Lya den Ouden ◽  
Gerard L. Guit
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Preterm Infants ◽  
Predictive Factor ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia ◽  
Neurodevelopmental Outcome ◽  
Cranial Ultrasound ◽  
Resonance Imaging ◽  
Postmenstrual Age

In this prospective study, cranial ultrasound was performed to detect periventricular-intraventricular hemorrhage and periventricular leukomalacia in 33 preterm infants of less than 32 weeks' gestation. At 44 weeks postmenstrual age magnetic resonance imaging was performed to detect the stage of myelination. Neurodevelopmental outcome was assessed at 3 years of age in 31 children (2 children died in the first year of life). Significant correlations were found between neurodevelopmental outcome and ultrasound findings (χ2 = 32.8; P < .0001) and stage of myelination (χ2 = 20.5; P < .0005). To establish the criterion with the best predictive factor, multiple regression analysis was performed with outcome as dependent variable and periventricular-intraventricular hemorrhage, periventricular leukomalacia, and stage of myelination as independent variables. It appeared that the detection of periventricular leukomalacia with ultrasound showed the best predictive factor for neurodevelopmental outcome. Routine magnetic resonance imaging at 44 weeks postmenstrual age should not be performed just for the purpose of predicting neurodevelopmental outcome more reliably.

scholarly journals Lack of Progression of Intraventricular Hemorrhage in Premature Infants: Implications for Head Ultrasound Screening

2019 ◽  
Author(s):  
Lawrence Rhein ◽  
Jaclyn Daigneault ◽  
Alexandra Dube ◽  
Heather White ◽  
Qiming Shi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Medical Center ◽  
Prolonged Mechanical Ventilation ◽  
Ultrasound Screening ◽  
Increased Risk ◽  
Grade Iii ◽  
Severe Grade

Abstract Background: Premature infants are known to be at increased risk for intraventricular hemorrhage (IVH) in the first week of life. IVH may be “mild” (grade I or II) or “severe” (grade III or IV). A classification of mild is less frequently associated with later morbidity. Severe grade IVH may be associated with death or severe neurodevelopmental disability. Mild IVH is generally considered a static, non-progressive disease. Thus, infants that do not present with IVH or who present with mild IVH are unlikely to advance to severe IVH. Consequently, after initial imaging demonstrates a normal result, subsequent head ultrasounds (HUS) may be unnecessary.Methods: This is a retrospective, single-center study. We identified all preterm infants with birth gestational age </= 32 0/7 weeks admitted to the University of Massachusetts Memorial Medical Center Neonatal Intensive Care Unit between January 1, 2011 and December 31, 2016 who received a head ultrasound (HUS) during hospitalization. Each individual ultrasound was classified according to the attending radiologist’s documentation. Grades of IVH were defined per the Papile classification. Initial HUS was defined as HUS performed on day of life 3-10. Every subsequent HUS throughout hospitalization was read and recorded.Results: We identified 682 eligible preterm infants. Of these, 88 were excluded for lack of HUS data, 237 had initial HUS out of inclusion timing window (day of life 3-10), and 4 were excluded for other conditions associated with intraventricular hemorrhage, leaving 353 infants for analysis. Initial findings of severe IVH were relatively rare in this cohort. Of the 343 (97%) infants who had mild IVH (grade II or less) at time of initial screening, only 4 (1.2%) progressed to severe (grade III or IV). Each of these infants required mechanical ventilation for at least 40 days.Conclusions: Based on the results of this analysis, premature infants who have a normal (no IVH) HUS or mild IVH (grade I or II) on initial routine screening HUS without other risk factors may not require follow-up HUS. Infants with prolonged mechanical ventilation may require further screening despite reassuring initial HUS findings.

scholarly journals P82 NUn score validation at a district general hospital

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Jacob Rapier ◽  
Steven Hornby ◽  
Jacob Rapier
Keyword(s):  
Positive Predictive Value ◽  
Anastomotic Leak ◽  
Confidence Intervals ◽  
Predictive Value ◽  
External Validation ◽  
District General Hospital ◽  
Anastomotic Leaks ◽  
Upper Gi ◽  
Increased Risk ◽  
Operative Complications

Abstract Introduction The NUn score was created to try and predict the risk of anastomotic leak or major complications (using the Clavien- Dindo classification) from upper GI resections with an oesophageal anastomosis. A score of &gt; 10 was used to predict an increased risk. In this study we attempt validation. Methods A database of 101 patients was studied, who underwent an Oesophagectomy for cancer between March 2017 and 2020. 72 patients had complete Post-operative day 4 bloods, needed to calculate the score. These patients were then studied for post-operative complications. Results A total of 12 patients had a NUn score of &gt; 10 (16.67%). There was 1 death (1.37%) and 11 anastomotic leaks (15.28%). Of these the NUn score did not predict the death and predicted 8 of the 11 anastomotic leaks. From our data Conclusion From our analysis the NUNs score cannot be shown to be sensitive, specific or have useful positive predictive value. The average Nun score was not reliable, with confidence intervals crossing 10. There may be some merit in using the test for its negative predictive value, but further analysis into this is needed. The results of this audit are consistent with previous efforts at external validation.

scholarly journals Language Delay Is Not Predictable from Available Risk Factors

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Philip Wilson ◽  
Fiona McQuaige ◽  
Lucy Thompson ◽  
Alex McConnachie
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Male Gender ◽  
Language Delay ◽  
Predictive Capacity ◽  
Factors Associated ◽  
Health Visitors

Aims. To investigate factors associated with language delay in a cohort of 30-month-old children and determine if identification of language delay requires active contact with families.Methods. Data were collected at a pilot universal 30-month health contact. Health visitors used a simple two-item language screen. Data were obtained for 315 children; language delay was found in 33. The predictive capacity of 13 variables which could realistically be known before the 30-month contact was analysed.Results. Seven variables were significantly associated with language delay in univariate analysis, but in logistic regression only five of these variables remained significant.Conclusion. The presence of one or more risk factors had a sensitivity of 89% and specificity of 45%, but a positive predictive value of only 15%. The presence of one or more of these risk factors thus can not reliably be used to identify language delayed children, nor is it possible to define an “at risk” population because male gender was the only significant demographic factor and it had an unacceptably low specificity (52.5%). It is not possible to predict which children will have language delay at 30 months. Identification of this important ESSENCE disorder requires direct clinical contact with all families.

scholarly journals Predictive Value of Cranial Ultrasound for Neurodevelopmental Outcomes of Very Preterm Infants with Brain Injury

2018 ◽  
Vol 131 (8) ◽  
pp. 920-926 ◽  
Author(s):  
Xue-Hua Zhang ◽  
Shi-Jun Qiu ◽  
Wen-Juan Chen ◽  
Xi-Rong Gao ◽  
Ya Li ◽  
...  
Keyword(s):  
Brain Injury ◽  
Preterm Infants ◽  
Predictive Value ◽  
Cranial Ultrasound ◽  
Neurodevelopmental Outcomes ◽  
Very Preterm Infants ◽  
Very Preterm

scholarly journals Value of transcranial ultrasound screening for the preterm in the neonatal ICU

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S B Ali ◽  
A S Abdelrahman ◽  
M I Hassan
Keyword(s):  
Gestational Age ◽  
Imaging Modality ◽  
Periventricular Leukomalacia ◽  
Transcranial Ultrasound ◽  
Radiology Department ◽  
Preterm Neonates ◽  
Cranial Ultrasound ◽  
Ultrasound Screening ◽  
Agenesis Of Corpus Callosum ◽  
Neonatal Icu

Abstract Background preterm neonates less than 37 weeks of gestational age are more liable to hemorrhagic and ischemic brain lesions due to the immaturity of capillary bed, cerebral auto-regulation and vascular anastomosis, with consequent adverse outcome, poor cognitive development, and cerebral palsy. Cranial ultrasound is a safe imaging modality with no need to radiation exposure or sedation. Aim of the Work to evaluate the usefulness of universal cranial ultrasound screening in preterm neonates in the neonatal ICU with gestational age between 28 and 37 weeks to detect the different intra cranial pathologies in this pediatric group. Patients and Methods After taking approval by the Radiology Department Committee of the Faculty of Medicine, Ain shams University, the current study was performed on all preterm neonates (50) admitted to neonatal ICU in Ain shams hospital between 28 and 37 weeks of gestational age, between the third and seventh day of life, from July 1, 2017 to April 1, 2018 were included in the study. Results The study showed normal transcrainal ultrasound (72.0%), Germinal matrix hemorrhage (10.0%), Intraventricular hemorrhage (6.0%), Periventricular leukomalacia (6.0%), Congenital anomalies is Dandy walker malformation (2.0%), Chiari malformation (0.0%), Agenesis of corpus callosum (2.0%) and Porencephalic cyst (2.0%) of finding of ultrasound. Conclusion The importance of preterm screening by cranial ultrasound is sustained by the observation that most preterm neonates with abnormal CUS are usually asymptomatic. Only occasionally these patients develop symptoms.Linear high frequency probe of ultrasound was of great benefit in better visualization of anatomical details and mild pathological lesions.

Intraventricular Hemorrhage and Periventricular Leukomalacia in Preterm Infants

2004 ◽  
Vol 104 (2) ◽  
pp. 225-231 ◽  
Author(s):  
Patrizia Vergani ◽  
Anna Locatelli ◽  
Valentina Doria ◽  
Francesca Assi ◽  
Giuseppe Paterlini ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia

Protecting TPN and Lipid Infusions from Light: Reducing Hydroperoxides in NICU Patients

2001 ◽  
Vol 20 (2) ◽  
pp. 17-22 ◽  
Author(s):  
Lisa Baird
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Periventricular Leukomalacia ◽  
Cellular Level ◽  
High Load ◽  
Antioxidant Systems ◽  
Term Infants ◽  
Fat Emulsions ◽  
Patients At Risk ◽  
Intravenous Fat Emulsions

The use of total parenteral nutrition (TPN) and intravenous fat emulsions in sick or preterm infants is often required to maintain adequate nutrition, yet recent research has shown that when exposed to light these nutrients are altered and deliver a high load of exogenous toxic hydroperoxides to already compromised infants. Hydroperoxides cause damage at the cellular level unless mediated by the body’s antioxidant systems. NICU patients are, by definition, patients at risk. Preterm infants have low antioxidant reserves and, like sick term infants, typically suffer significant oxidative stress. Endogenous hydroperoxides alone may overwhelm defenses. The addition of hyperperoxides from light-exposed TPN or fat emulsions increases the risk of tissue damage. Hydroperoxides have been associated with hypoxicischemic encephalopathy, intraventricular hemorrhage, periventricular leukomalacia, chronic lung disease, retinopathy of prematurity, and necrotizing enterocolitis. By protecting these infusates from light, bedside nurses can reduce the amount of hydroperoxides infused and protect NICU patients from the associated risks.

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