Preterm White Matter Injury: A Prospective Cohort Study

Objective To determine the incidence and risk factors of preterm white matter injury [WMI; periventricular-intraventricular hemorrhage (PIVH) and/or periventricular leukomalacia (PVL)]. Design Prospective cohort study. Setting Level-3 neonatal intensive care unit. Patients Inborn preterm neonates (n=140) delivered at Methods Serial cranial ultrasounds were performed at postnatal ages of 3 days (+/- 12 hour), 7 (+/- 1) days, 21 (+/- 3) days and 40 (+/- 1) weeks postmenstrual age (PMA). PIVH and PVL were graded as per Volpe and De-Vries criteria, respectively. Univariate followed by multivariate analysis was done to evaluate risk factors for PIVH and PVL. Outcome measures The primary outcome was the incidence of preterm WMI. The secondary outcomes were evaluation of risk factors and natural course of WMI. Results The mean (range) gestation and birth weight of enrolled neonates were 29.7 (24-36) weeks and 1143 (440-1887) g, respectively. PIVH occurred in 25 (17.8%) neonates. PVL occurred in 34 (24.3%) neonates. None of them were grade III or IV PVL. Preterm WMI (any grade PIVH and/or PVL) occurred in 52 (37.1%) neonates. Severe PIVH (grade III) and cystic PVL occurred in 7 (5%) and 5 (3.6%) neonates, respectively. On multivariate analysis, none of the presumed risk factors were associated with PIVH. However, hemodynamically significant patent ductus arteriosus, and apnea of prematurity were significantly associated with increased risk of PVL. Conclusions Significant WMI occurred only in one-third of the cohort, which is comparable to that described in literature from the developed countries.

Automated summary

The study aimed to determine the incidence and risk factors of preterm white matter injury in preterm neonates. The results showed that preterm WMI occurred in 37.1% of neonates, with PIVH occurring in 17.8% and PVL in 24.3%. Risk factors were not associated with PIVH, but hemodynamically significant patent ductus arteriosus and apnea of prematurity were significantly associated with increased risk of PVL.