We appreciate the comments of Drs. Mittendorf, Pryde, and Roizen to our manuscript on isolated LSV in preterm infants.1
As mentioned by Mittendorf and colleagues, LSV has been associated with IVH. However, the objective of our study was to determine the prevalence of LSV in premature infants (<35 weeks) with an otherwise normal head ultrasound. Patients with IVH were excluded to avoid a confounding effect on the neurodevelopmental outcome analysis in our study. Therefore, it is not surprising that we reported a lower prevalence of LSV than the MagNET study (4.6 vs 9.6%).2
The speculation that umbilical vessel vasculopathy may mirror intracranial vasculopathy in the fetus is worthy of further investigation. In our retrospective review, we did not have placental pathology reports available for analysis. However, as we suggested in our paper, early onset LSV (occurring in the first 10 days of life) might be a reflection of an in utero inflammatory insult and it is reasonable to speculate that funisitis might be associated with such an insult. In our study, we did not examine the use of magnesium sulfate for maternal tocolysis as a risk factor for the development of LSV, and we can only speculate that the use of magnesium sulfate might be associated with LSV.
We look forward to reading Mittendorf and colleagues, the findings of and future long-term neurodevelopmental follow-up studies of very low birth weight infants with LSV.
Hemachandra AH, Oravec D, Collin M, Tafari N, Mhanna MJ . Early and late postnatal identification of isolated lenticulostriate vasculopathy in preterm infants: associated findings. J Perinatol 2003;23:20–23.
Covert R, Kohn J, Yousefzadeh D, Ben-Ami T, Mittendorf R . Thalamostriate vasculopathy in neonates in the MagNET trial: association with placental funisitis and intraventricular hemorrhage. Pediatr Res 1999;45(Part2):192A.