White matter injury in the preterm infant: an important determination of abnormal neurodevelopment outcome
Section snippets
Background
Injury to periventricular white matter represents the most significant problem contributing to neonatal mortality as well as long-term neurologic deficits in the premature infant. Two lesions account for the majority of white matter injury in the premature infant, namely cystic periventricular leukomalacia (PVL) and intraparenchymal white matter hemorrhage associated with periventricular–intraventricular hemorrhage (PV–IVH). 1, 2Cranial ultrasonography has been pivotal in defining the magnitude
Background
PVL refers to necrosis of white matter adjacent to the external angles of the lateral ventricles and is regarded as the principal ischemic lesion of the premature infant [3]. The incidence of PVL has ranged from 4–15% (see Refs. 3, 4for review). Part of this wide variation in incidence relates to the sonographic definition used by various authors to describe the condition. Most reports frequently include infants with IVH, and the ipsilateral intraparenchymal hemorrhage and transient hyperechoic
Background
PV–IVH is the most common serious neurologic lesion of the neonatal period occurring predominantly in the premature infant. Although the incidence of PV–IVH appears to be declining, the occurrence of severe IVH alone or with associated intraparenchymal involvement remains a significant problem particularly in the very low birthweight infant <1000 g birthweight 1, 72, 73(Table 2). Thus, the unilateral involvement of white matter commonly referred to as an intraparenchymal echogenicity (IPE) or
Conclusions
Injury to periventricular white matter remains a significant problem affecting approximately 15–20% of extremely premature infants. The outcome following such injury is invariably unfavorable with motor as well as cognitive impairment. A clearer understanding of pathogenesis is critical in order to provide targeted interventions to those infants at highest risk.
References (134)
- et al.
White matter damage in preterm newborns—an epidemiologic perspective
Early Hum Dev
(1990) - et al.
White matter necrosis in the very low birth weight infants: neuropathologic and ultrasonographic findings in infants surviving six days or longer
J Pediatr
(1990) - et al.
Developmental changes of glial acidic fibrillary protein and myelin basic protein in perinatal leukomalacia: relationship to predisposing factors
Brain Dev
(1984) - et al.
Heterogeneity of cerebral vasoreactivity in preterm infants supported by mechanical ventilation
J Pediatr
(1989) - et al.
The association of fetal and newborn acidosis with severe periventricular leukomalacia in the preterm infant
Am J Obstet Gynecol
(1990) - et al.
The effect of patent ductus arteriosus on flow velocity in the anterior cerebral arteries: ductal steal in the premature newborn infant
J Pediatr
(1981) - et al.
Elevation of amniotic fluid interleukin 6- (IL-6), IL-8, and granulocyte stimulating factor (G-CSF) in term and preterm parturition
Cytokines
(1993) - et al.
Endotoxin leukoencephalopathy in the telencephalon of the newborn kitten
J Neurol Sci
(1976) - et al.
Maternal endotoxemia, fetal anomalies and central nervous system damage: a rat model of a human problem
Am J Obstet Gynecol
(1976) - et al.
Immunohistochemical expression of tumor necrosis factor ∝ in neonatal leukomalacia
Pediatr Neurol
(1996)
High expression of tumor necrosis factor ∝ and interleukin 6 in periventricular leukomalacia
Am J Obstet Gynecol
Interleukin-I receptor antagonism inhibits ischemic and excitotoxic neuronal damage in the rat
Brain Res Bull
Antenatal origin of neurologic damage in newborn infants. I. Preterm infants
Am J Obstet Gynecol
Echoencephalographic findings in neonates associated with maternal cocaine and methamphetamine use: incidence and clinical correlates
J Pediatr
Relationship between mean airway pressure, cardiac output and organ blood flow with normal and decreased respiratory compliance
J Pediatr
Evaluation of periventricular leukomalacia during the neonatal period and infancy: correlation of imaging and postmortem findings
Early Hum Dev
Intraventricular hemorrhage following volume expansion after hypovolemic hypotension in the newborn beagle
J Pediatr
The associations of rapid volume expansion and intraventricular hemorrhage in the preterm infant
J Pediatr
Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage
J Pediatr
Relationship of uric acid concentrations and severe intraventricular hemorrhage/leukomalacia in the premature infant
J Pediatr
A randomized placebo controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24–28 weeks gestation
Am J Obstet Gynecol
Beneficial effects of combined use of prenatal steroids and postnatal surfactant on preterm infants
Am J Obstet Gynecol
March of Dimes Multicenter Study Group. The effect of glucocorticoid therapy in the very premature infant
Am J Obstet Gynecol
Evidence from multicenter networks on the current use and effectiveness of antenatal corticosteroids in low birthweight infants
Am J Obstet Gynecol
Relationship between periventricular intraparenchymal echodensities and germinal matrix-intraventricular hemorrhage in the very low birth weight neonate
Pediatrics
Bilateral cystic periventricular leukomalacia in the premature infant: associated risk factors
Pediatrics
Perinatal risk factors for the development of extensive cystic leukomalacia
Am J Dis Child
Late onset cystic leukomalacia
Arch Dis Child
Periventricular leukomalacia of infancy: a form of neonatal anoxic encephalopathy
Arch Neurol
Pathogenesis and evolution of periventricular leukomalacia in infancy
Arch Neurol
Periventricular leukomalacia in neonates: complications and sequelae
Arch Dis Child
The human periventricular arterial blood supply and the anatomy of cerebral infarctions
Eur Neurol
Development of cerebrovascular architecture and its relationship to periventricular leukomalacia
Arch Neurol
Cerebral angioarchitecture and perinatal brain lesions in premature and full term infants
Acta Neurol Scand
Anatomic features of the developing brain implicated to hypoxic–ischemic injury
Brain Pathol
Regulation of local cerebral blood flow in normal and hypoxic newborn dogs
Ann Neurol
Regional cerebral blood flow after hemorrhagic hypotension in the preterm, near term and term lamb
Pediatr Res
Selective reduction of blood flow to white matter during hypotension in newborn dogs: a possible mechanism of periventricular leukomalacia
Ann Neurol
Impaired autoregulation of cerebral blood flow in the distressed newborn infant
J Pediatr
Association of septic shock caused by early onset Group B streptococcal sepsis and periventricular leukomalacia in the preterm infant
Pediatrics
Mean arterial blood pressure and neonatal cerebral lesions
Arch Dis Child
Severe hypocarbia in preterm infants and neurodevelopmental deficit
Acta Paediatr Scand
Hypocarbia and cystic periventricular leukomalacia in premature infants
Arch Dis Child
Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high frequency jet ventilation
Pediatrics
Episodes of apnea and bradycardia in the preterm newborn: impact on cerebral circulation
Pediatrics
The influence of immaturity on hypoxic–ischemic brain damage in the rat
Ann Neurol
Vulnerability of oligodendroglia to glutamate: pharmacology, mechanisms and prevention
J Neurosci
Acquired perinatal leukoencephalopathy
Ann Neurol
Cited by (197)
Brain MRI findings of prelingually deaf children and cochlear implant outcome: Preliminary results
2022, International Journal of Pediatric OtorhinolaryngologyPeriventricular- intraventricular hemorrhage in the premature infant- A historical perspective
2022, Seminars in PerinatologyEarly intervention and neurodevelopmental outcome of infants with posthemorrhagic hydrocephalus: A case series and literature review
2021, Clinical Neurology and NeurosurgeryBehavioral and neuroanatomical outcomes in a rat model of preterm hypoxic-ischemic brain Injury: Effects of caffeine and hypothermia
2018, International Journal of Developmental Neuroscience