The Indicence of Cystic Periventricular Leukomalacia and Severe Intracranial Hemorrhage Has Not Changed in Very Low Birth-Weight, Conventionally-Ventilated Premature Infants (1982-1997)

Abstract 1524 Poster Session III, Monday, 5/3 (poster 46)

Background: Mechanically-ventilated very low birthweight (VLBW) premature infants are at high risk for developing cystic periventricular leukomalacia (PVL) and severe intracranial hemorrhage (Gr 3 or 4 ICH). Although some have reported a decline in ICH since the early 1980s, others have found either no change or an increase in its occurrence. Additionally, to date no one has assessed the incidence of cystic PVL over time. We have enrolled a large number of VLBW infants into a series of federally-funded trials examining risk factors associated with brain injury. The objective of the current investigation was to address the occurrence of cystic PVL and severe ICH over time in this high risk population during both the pre-surfactant and surfactant eras. Methods: From our comprehensive data base, we examined the occurrence of cystic PVL and Grade 3 or 4 ICH in a population of infants born between 1982 and 1997 who were: 1) inborn; 2) GA < 32 weeks; 3) BW < 1500 grams; and 4) required conventional mechanical ventilation. Serial neurosonograms were performed during the first 72 hours of life and weekly thereafter. Results: 1,949 inborn premature infants met the inclusion criteria. The incidences over time of cystic PVL and Gr 3 or 4 ICH is depicted in the Figure. No significant changes in either has occurred over time. Conclusions: The incidence of cystic PVL, as well as that of Gr 3 or 4 ICH, has remained essentially unchanged over the past 1 ½ decades, seemingly unaffected by antenatal steroids or surfactant Rx.

Fig 1

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*This study was supported in part by NIH 5RO1 HD