Punctate white matter lesions of preterm infants: Risk factor analysis. (September 2019)

• Record Type: Journal Article
• Authors: Parodi, Alessandro; Malova, Mariya; Cardiello, Valentina; Raffa, Sarah; Re, Martina; Calevo, Maria Grazia; Severino, Mariasavina; Tortora, Domenico; Morana, Giovanni; Rossi, Andrea; Ramenghi, Luca Antonio
• Is Part Of: European journal of paediatric neurology. Volume 23:Number 5(2019:Sep.)
• Page Start: 733
• Page End: 739
• Publication Date: 2019-09
• Subjects: Neonatology -- Preterm -- Brain lesion -- White matter -- MRI; Pediatric neurology -- Periodicals; Nervous System Diseases -- Periodicals; Child -- Periodicals; Infant -- Periodicals; Neurologie pédiatrique -- Périodiques; Pediatric neurology; Electronic journals; Periodicals; Electronic journals; 618.928
• DOI: 10.1016/j.ejpn.2019.06.003
• Languages: English
• ISSNs: 1090-3798

Abstract

Abstract: Aim: Punctate white matter lesions (PWML) are frequently detected in preterm infants undergoing brain MRI at term equivalent age (TEA). The aims of this study were to assess prevalence of PWML and to identify risk factors for PWML in VLBW infants. Methods: Brain MRI scans obtained at TEA and clinical charts of a consecutive sample of very low birth weight (VLBW) infants admitted to Gaslini Children's Hospital NICU between 2012 and 2016 were retrospectively analyzed. MRI protocol included Susceptibility Weighted Imaging (SWI) sequence in order to identify hemosiderin depositions as a result of previous microbleeds. PWML were classified according to their number (≤6 lesions and >6 lesions) and signal characteristics (SWI+ lesions and SWI− lesions). Univariate and multivariable analysis were performed in order to identify risk factors for PWML (as a whole) and for each subgroup of PWML. Results: 321 VLBW infants were included. PWML were identified in 61 subjects (19%), 26 of whom (8% of the study population) had more than 6 lesions. Risk factors for PWML (as a whole) were higher birth weight (OR = 1.001; p = 0.04) and absent or incomplete antenatal steroid course (OR = 2.13; p = 0.02). Risk factors for >6 PWML were need for intubation (OR = 11.9; p = 0.003) and higher Apgar score at 5 min (OR = 1.8; p = 0.02). Presence of GMH-IVH was the only identified risk factor for SWI + lesions. Conclusions: Our results confirm the high prevalence of PWML among VLBW infants. Differentiation between SWI+ and SWI− lesions is crucial as they have different risk factors and may likely represent two different entities. Highlights: Punctate white matter lesions are frequent on brain MRI in preterm infants. Some PWLM are visible on SWI sequence, compatible with presence of hemosiderin. Absent or incomplete antenatal steroid course is a risk factor for PWML. Respiratory distress requiring intubation is a risk factor for the multiple (>6) PWML. PWML visible and not visible on SWI sequence have different risk factors.