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Diagnosis of intracranial lesions in very‐low‐birthweight infants by ultrasound: incidence and association with potential risk factors
Author(s) -
Hesser U.,
KatzSalamon M.,
Mortensson W.,
Flodmark O.,
Forssberg H.
Publication year - 1997
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.1997.tb18305.x
Subject(s) - medicine , white matter , subependymal zone , gestational age , hyperintensity , intraventricular hemorrhage , pediatrics , germinal matrix , echoencephalography , incidence (geometry) , asphyxia , ventriculomegaly , pregnancy , pathology , radiology , fetus , magnetic resonance imaging , genetics , physics , biology , optics
This study was designed to determine the frequencies of germinal matrix and ventricular haemorrhages as well as lesions in the white matter diagnosed by ultrasonography. In subsequent studies the effects of perinatal brain lesions on the cognitive and motor development of preterm children will be presented. Lesions of the white matter are probably more damaging than intraventricular and subependymal bleeds. Therefore, a modified classification of the lesions was used, clearly separating bleeds from white matter pathology. The study includes 291 infants with a body weight of ≤1500 g consecutively admitted to the neonatal intensive‐care unit at Karolinska Hospital from 1988 to 1993. Fifty‐four (18.9%) died before 6 months. Two hundred and sixty‐three infants were examined using ultrasound. Pathology due to bleeding was classified into three grades (B 1–3 ) similar to Papile's first three grades. Pathology in periventricular white matter was classified into four groups (W 1–4 ): W 1 = subtle and W 2 = distinctive white matter echodensities; W 3 = cyst formation; W 4 = large, intense echodensity. Forty‐nine patients had abnormalities in the periventricular white matter (15 W 1 , 12 W 2 , 11 W 3 and 11 W 4 ) and 58 had subependymal (B 1 = 29) or ventricular bleeding without (B 2 = 13) or with dilatation (B 3 = 16). Ventilator treatment was significantly associated with both B and W lesions. Low gestational age, low birthweight, small for gestational age, pre‐eclampsia and caesarean section were significantly associated with B lesions whereas asphyxia, surfactant treatment, male patient sex and outborn were associated with W lesions; B 1–3 and W 1–4 lesions were thus partly associated with different potential risk factors. The pre‐ and perinatal potential risk factors could only partly explain the variance in the frequency of B and W lesions, indicating that there are yet unidentified risk factors for intracranial ultrasonographic pathology.