Outcome of Preterm Infants with Transient Cystic Periventricular Leukomalacia on Serial Cranial Imaging Up to Term Equivalent Age

• Type of Material: Article
• Authors: Subrata Sarkar, University of Michigan Health System; Seetha Shankaran, Wayne State University; John Barks, University of Michigan Health System; Barbara T. Do, RTI International; Abbot R. Laptook, Brown University; Abhik Das, RTI International; Namasivayam Ambalavanan, University of Alabama Birmingham; Krisa P. Van Meurs, Stanford University; Edward F. Bell, University of Iowa; Pablo J. Sanchez, Nationwide Childrens Hospital; Susan R. Hintz, Stanford University; Myra H. Wyckoff, University of Texas Southwestern; Barbara Stoll, Emory University; Waldemar A. Carlo, University of Alabama Birmingham; David Carlton, Emory University; Ira Adams-Chapman, Emory University
• Language: English
• Date: 2018-04-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpeds.2017.12.010
• Title of Journal or Parent Work: Journal of Pediatrics
• ISSN: 0022-3476
• Volume: 195
• Start Page: 59
• End Page: +
• Grant/Funding Information: The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Research Resources, and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network’s Generic Database and Follow-up Studies through cooperative agreements.
• Keywords: Life Sciences & Biomedicine; ULTRASOUND; Pediatrics; LEUCOMALACIA; Science & Technology
• Research Categories: Sociology, Public and Social Welfare; Statistics; Environmental Sciences

Abstract

Objective: To determine the outcome of preterm infants whose cystic periventricular leukomalacia “disappeared” on serial screening cranial imaging studies. Study design: Infants ≤26 weeks of gestation born between 2002 and 2012 who had cranial imaging studies at least twice, the most abnormal study at <28 days of age and another closest to 36 weeks, were reviewed. The outcome of late death (after 36 weeks postmenstrual age) or neurodevelopmental impairment (NDI) in surviving infants at 18-26 months corrected age was compared between the infants with no cystic periventricular leukomalacia on both studies and cystic periventricular leukomalacia that disappeared (cystic periventricular leukomalacia at <28 days but not at 36 weeks), persisted (cystic periventricular leukomalacia on both studies), or appeared late (cystic periventricular leukomalacia only at 36 weeks). Predictors of NDI were evaluated by logistic regression. Results: Of 7063 eligible infants, 433 (6.1%) had cystic periventricular leukomalacia. Among the 433 infants with cystic periventricular leukomalacia, cystic periventricular leukomalacia disappeared in 76 (18%), persisted in 87 (20%), and 270 (62%) had late cystic periventricular leukomalacia. Loss to follow-up ranged between 3% and 13%. Death or NDI was more common in infants with disappeared cystic periventricular leukomalacia compared with those with no cystic periventricular leukomalacia (38 of 72 [53%] vs 1776 of 6376 [28%]; OR [95% CI] 2.8 [1.8-4.6]). Disappeared, persistent, and late cystic periventricular leukomalacia were all also independently associated with NDI (OR 1.17, 1.21, and 1.16, respectively). Conclusions: Infants with “disappeared” cystic periventricular leukomalacia are at increased risk of adverse outcome similar to infants with persistent or late cystic periventricular leukomalacia.