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a Department of Neonatology,
Wilhelmina Children's Hospital, Utrecht, The Netherlands, b Department of Medical statistics, c Department of Obstetrics, University Hospital Utrecht
Correspondence to: Dr LS de Vries Department of Neonatology Wilhelmina Children's Hospital PO Box 18009 3501 CA Utrecht, The Netherlands. Email: l.devries{at}wkz.azu.nl
Accepted 5 August 1997
AIM
To assess the prevalence of an antenatal onset
of haemorrhagic and/or ischaemic lesions in preterm infants; to
identify possibly related obstetric risk factors.
METHODSA prospective cohort study was made of
1332 infants born at less than 34 completed weeks, using cranial
ultrasound, for the presence of antenatal brain lesions (group A)
involving the periventricular white matter (PVWM) or central grey
matter. Entry criteria were presence of (i) cysts in the PVWM < 7 days; (ii) increased PVWM echogenicity < 6 hours, confirmed to be
white matter necrosis at post mortem examination; (iii) a unilateral
porencephalic cyst < 3 days; (iv) an intraventricular haemorrhage with
unilateral parenchymal involvement < 6 hours; and (v) symmetrical
areas of increased echogenicity in the thalami, confirmed to be areas
of calcification on post mortem examination. Group B consisted of infants with a normal early neonatal ultrasound scan with subsequent development of the lesions mentioned above.
RESULTSTwenty four cases met the entry criteria
for group A: 17 died and five of the seven survivors developed cerebral
palsy at follow up. Of the whole cohort, 156 (11.7%) infants died and
in 63 (40.3%) of these a large ultrasound lesion was present. In 17 (26.9%) cases this lesion was considered to be of antenatal onset.
Sixty eight of the 1176 (5.8%) survivors developed cerebral palsy and
this was attributed to antenatal onset in five (7.3%). A comparison of
the obstetric risk factors between the infants in group A and B, who
either died or developed cerebral palsy, showed a significant
difference in gestational age between the two groups (30.9 vs 28.9 weeks; p<0.001). Prolonged rupture of membranes
was significantly more common in group B (p=0.03), while an ominous
cardiotachogram was significantly more common in group A (p=0.01), and
this remained significant following logistic regression analysis.
CONCLUSIONSAlthough these data suggest that most
preterm infants did not develop their brain lesions in utero, an
antenatal onset was not uncommon, especially in those with PVWM
lesions, who did not survive the neonatal period.
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