Developmental Assessment of Preterm Infants at Two Years of Age with Periventricular Leukomalacia.

Lee,  Hyun Jung; Park,  Sung Ho; Na,  Kyung Hee; Park,  Sun Young; Kim,  Eun Young; Kim,  Kyoung Sim; Kim,  Yong Wook; Kim,  Sae Jong

Original Article

Journal of the Korean Society of Neonatology 2002;9(2):167-175.
Published online November 1, 2002.

Developmental Assessment of Preterm Infants at Two Years of Age with Periventricular Leukomalacia.

Hyun Jung Lee, Sung Ho Park, Kyung Hee Na, Sun Young Park, Eun Young Kim, Kyoung Sim Kim, Yong Wook Kim, Sae Jong Kim

¹Department of Pediatrics, Kwangju Christian Hospital, Gwangju, Korea. tomato0423@hanmail.net
²Department of Radiology, Kwangju Christian Hospital, Gwangju, Korea.

뇌실주위 백질연화증 미숙아에서 2세 발달 평가

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Abstract

PURPOSE
The study was to determine clinical characteristics of periventricular leukomalacia (PVL) in premature infants and evaluate usefulness of brain MRI as a diagnostic tool in predicting degree of PVL to severity of neurological sequelae at 2 years of age.
METHODS
The subjects included twenty premature infants admitted to NICU of Kwangju Christian Hospital from June 1993 to February 1999 whose 2 year follow up was possible. The diagnosis of PVL was made by brain MRI and severity of PVL was divided into 3 grades based on its degree of white matter volume loss.
RESULTS
The infants with grade I PVL was 2 (10%), grade II was 14 (70%), grade III was 4 (20%). The mean gestational age was 32.0+/-1.7 weeks and mean birth weight was 1,770+/-370 g. The risk factors associated with PVL were mechanical ventilator care, respiratory distress syndrome, prolonged rupture of membrane, and neonatal seizures. Two patient were diagnosed with PVL later by MRI when increased periventricular echodensity noted on initial neurosonogram improved on subsequent follow up neurosonograms. Accompanied neurological sequelae included motor palsy, language delay, visual impairment, squint and epilepsy. At 2 years of age, infants with grade 1 PVL could walk without support, most (71%) of grade II could crawl and stand holding and most (75%) of grade III could sit with arm support.
CONCLUSION
Brain MRI is regarded as a precise tool in diagnosing PVL. The severity of PVL on brain MRI significantly correlated with degree of the motor developmental delay.

Key Words: Periventricular leukomalacia; Prematurity; Brain MRI; Degree of PVL; Neurologic sequela