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a Department of
Neonatology, Jeanne de Flandre' s Hospital, Lille, France, b Department of Neonatology, UMC, Wilhelmina
Children's Hospital, Utrecht, The Netherlands, c Department of Paediatric
Physiotherapy, UMC, Wilhelmina Children's Hospital
Correspondence to: Dr de Vries, Department of Neonatology, UMC, Wilhelmina Children's Hospital, KE 04.123.1, PO Box 85090, 3508 AB Utrecht, The Netherlands l.devries{at}wkz.azu.nl
Accepted 24 November
2000
AIMS
To compare the
ultrasound (US) evolution and neurodevelopmental outcome of infants
with localised (grade II) and extensive (grade III) cystic
periventricular leucomalacia (c-PVL).
METHODSOver a nine
year period, c-PVL was diagnosed in 96/3451 (2.8%) infants in two
hospital cohorts. Eighteen were excluded from the study. Thirty nine
infants with grade II PVL were compared with 39 infants with grade III PVL.
RESULTSThe two
populations were comparable for gestational age and birth weight. In
infants with grade II PVL, cysts were noted to develop more often after
the first month of life (53%) in contrast with grade III PVL (22%)
(odds ratio (OR) 3.81 (95% confidence interval (CI) 1.19 to 12.63)).
Cysts were also more often unilateral in grade II (54%) than in grade
III PVL (0%) (OR indefinite; RR 3.17 (95% CI 2.16 to 4.64)). At 40 weeks postmenstrual age (PMA), cysts were no longer seen on US in 13/38
infants with grade II PVL, with ventriculomegaly being the only visible
sequel in nine cases. In grade III PVL, cysts were still present in 25 of the 27 surviving infants. Nine infants with grade II PVL were free of motor sequelae at follow up compared with one infant with grade III
PVL (OR 8.07 (95% CI 0.92 to 181.66)). Twenty two out of 29 children
with grade II PVL who developed cerebral palsy achieved independent
walking compared with 3/26 with grade III PVL (OR 75 (95% CI 11.4 to 662)).
CONCLUSIONSIn
the cohort studied, 50% of the infants with c-PVL had a more localised
form (grade II). In grade II PVL, the cysts developed beyond the first
month of life in more than half of the cases and were often no longer
visible, on US, at 40 weeks PMA. In order not to miss this diagnosis,
sequential US should also be performed beyond the first month of life.
Mild ventriculomegaly noted at term can sometimes be due to grade II
c-PVL. Cerebral palsy was slightly less common and tended to be less
severe in infants with grade II PVL than in those with grade III PVL.
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