Journal List > Korean J Perinatol > v.27(1) > 1013795

Shim and Chey: Risk Factors of Cystic Periventricular Leukomalacia in Preterm Infants with Gestational Ages of Less Than 32 Weeks according to Gestational Age Group

Abstract

Purpose:

The aim of the study was to determine the incidence of cystic periventricular leukomalacia (PVL) and identify the risk factors for cystic PVL in preterm infants with gestational age (GA) less than 32 weeks according to gestational age group.

Methods:

The medical records and brain imaging were reviewed for preterm infants with less than 32 weeks GA who lived more than 4 weeks and admitted to the neonatal intensive care unit at Inje University Sanggye Paik Hospital from January 2009 to June 2015. We determined the incidence and the risk factors for the development of cystic PVL in preterm infants according to GA group. Results: Incidence of cystic PVL was 15.1% (26/172). Multivariate analysis showed that intraventricular hemorrhage (IVH) [P=0.006, odds ratio (OR) 5.478, 95% confidence interval (CI) 1.641-18.285), oxygen uses over 28 days (P=0.025, OR 3.086, 95% CI 1.152-8.264), and NEC (P=0.042, OR 3.731, 95% CI 1.047-13.333) were independent risk factors for the developmental of cystic PVL. Subgroup analysis showed that pregnancy-induce hypertension and IVH were independent risk factors in preterm infants with GA of less than 28 weeks. Also, oxygen uses over 28 days and culture proven sepsis were independent risk factors in preterm infants with GA of 28+0-31+6 weeks.

Conclusion:

These results suggest that pregnancy-induce hypertension and IVH may increase the risk for the subsequent development of cystic PVL in preterm infants with GA of less than 28 weeks, and oxygen uses over 28 days and culture proven sepsis may increase in preterm infants with GA of 28+0-31+6 weeks.

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Table 1.
Analysis of Risk Factors Associated with Cystic PVL in Preterm Infants with Gestational Ages of Less than 32 Weeks
Risk factors Cystic PVL (n=26) Control (n=146) P-value
Maternal age 33 [19-40] 33 [21-43] 0.795
Cesarean section 20 (76.9) 96 (65.8) 0.263
Primiparity 14 (53.8) 52 (35.6) 0.078
PROM 7 (26.9) 48 (32.9) 0.549
Histologic chorioamnionitis 8 (30.8) 52 (35.6) 0.633
PIH 6 (23.1) 29 (19.9) 0.708
IUGR 3 (11.5) 15 (10.3) 0.738
Antenatal steroid 20 (76.9) 93 (63.7) 0.191
Gestational age (wks) 28.6 [23.3-31.9] 29.6 [23.6-31.9] 0.352
Birth weight (g) 1,153 [460-1,870] 1,195 [600-2,135] 0.359
Female 11 (42.3) 76 (52.1) 0.360
Apgar score      
  1 min 4 [0-7] 5 [1-9] 0.343
  5 min 7 [2-10] 7 [2-10] 0.143
IVH (≥grade 2) 7 (26.9) 8 (5.5) 0.001
Oxygen uses ≥28 days 19 (73.1) 55 (37.7) 0.001
Duration of invasive ventilation (days) 11 [0-185] 2 [0-114] 0.084
Dexamethasone 7 (26.9) 19 (13.0) 0.068
RDS 17 (65.4) 67 (45.9) 0.067
Pulmonary hemorrhage 4 (15.4) 5 (3.4) 0.031
Culture proven sepsis 7 (26.9) 14 (9.6) 0.013
Frequency of RBC transfusion 4.5 [0-48] 1 [0-29] 0.061
Rotavirus infection 10 (38.5) 29 (19.9) 0.037
NEC (≥stage 2) 5 (19.2) 9 (6.2) 0.025
pCO2 within 72 hours after birth <30 mmHg 11 (42.3) 44 (30.1) 0.220
pCO2 within 72 hours after birth >60 mmHg 17 (65.4) 68 (46.6) 0.077
Lowest platelet count during admission <100,000/mm3 10 (38.5) 20 (13.7) 0.002

Values are expressed as number (%) or medians and ranges in square brackets. Abbreviations: PVL, periventricular leukomalacia; PROM, premature rupture of membrane; PIH, pregnancy induced hypertension; IUGR, intrauterine growth restriction; IVH, intraventricular hemorrhage; RDS, respiratory distress syndrome; RBC, red blood cell; NEC, necrotizing enterocolitis.

Table 2.
Multiple Logistic Regression Analysis of Risk Factors Associated with Cystic in Preterm Infants with Gestational Ages of Less than 32 Weeks
  Odds Ratio 95% confidence Interval P-Value
VH (≥grade 2) 5.478 1.641-18.285 0.006
Oxygen uses ≥28 days 3.086 1.152-8.264 0.025
NEC (≥stage 2) 3.731 1.047-13.333 0.042

∗This analysis was performed while controlling for IVH (≥grade 2), and oxygen uses ≥28 days, pulmonary hemorrhage, culture proven sepsis, rotavirus infection, NEC (≥stage 2), and lowest platelet count during admission <100,000/mm

3 . Abbreviations: PVL, periventricular leukomalacia; VH, intraventricular hemorrhage; NEC, necrotizing enterocolitis.

Table 3.
Subgroup Analysis of Prenatal and Neonatal Risk Factors Associated with Cystic PVL in Preterm Infants with Gestational Ages of Less Than 28 Weeks and Gestational Ages of 28+0-31+6 Weeks
Risk factors Preterm Infants with Gestational Ages of Less than 28 Weeks Preterm Infants with Gestational Ages of 28+0-31+6 Weeks
Cystic PVL (n=10) Control (n=47) P-value Cystic PVL (n=16) Control (n=99) P-value
PIH 4 (40.0) 3 (6.4) 0.014 2 (12.5) 26 (26.3) 0.350
IUGR 2 (20.0) 0 0.028 1 (6.3) 15 (15.2) 0.464
IVH (≥grade 2) 5 (50.0) 6 (12.8) 0.007 2 (12.5) 2 (2.0) 0.092
Oxygen uses ≥28 days 10 (100) 41 (80.4) 0.577 9 (56.3) 14 (14.1) 0.001
Dexamethasone 7 (70%) 16 (34.0) 0.072 0 3 (3.0) 1.000
Pulmonary hemorrhage 3 (30.0) 3 (6.4) 0.060 1 (6.3) 2 (2.0) 0.365
Culture proven sepsis 3 (30) 9 (19.1) 0.672 6 (37.5) 5 (5.1) 0.001
Frequency of RBC transfusion 15 [3-48] 8 [0-29] 0.029 2 [0-24] 1 [0-20] 0.198
Rotavirus infection 3 (30.0) 10 (21.3) 0.680 7 (43.8) 19 (19.2) 0.029
NEC (≥stage 2) 2 (20.0) 5 (10.6) 0.594 3 (18.8) 4 (4.0) 0.055
Lowest platelet count during admission <100,000/mm3 5 (33.3) 5 (11.9) 0.061 5 (31.3) 10 (10.1) 0.020

Values are expressed as number (%) or medians and ranges in square brackets. Abbreviations: PVL, periventricular leukomalacia; PIH, pregnancy induced hypertension; IUGR, intrauterine growth restriction; IVH, intraventricular hemorrhage; RBC, red blood cell; NEC, necrotizing enterocolitis.

Table 4.
Multiple Logistic Regression Subgroup Analysis of Risk Factors Associated with Cystic PVL in Preterm Infants with Gestational Ages of Less than 32 Weeks Preterm Infants with Gestational Ages of Less than 28 Weeks
  Adjusted Odds Ratio o 95% Confidence Interval P-Value
PIH 7.813 1.229-50.000 0.029
IVH (≥grade 2) 5.581 1.097-28.400 0.038
∗This analysis was performed while controlling for PIH, IUGR, IVH (≥grade 2), and frequency of RBC transfusion. Preterm Infants with Gestational Ages of 28+0-31+6 Weeks
  Adjusted Odds Ratio 95% Confidence Interval P-Value
Oxygen uses ≥28 days 4.926 1.391-17.544 0.014
Culture proven sepsis 5.184 1.256-27.027 0.024

∗This analysis was performed while controlling for oxygen uses ≥28 days, culture proven sepsis, rotavirus infection, and lowest platelet count during admission <100,000/mm3. Abbreviations: PVL, periventricular leukomalacia; PIH, pregnancy induced hypertension; IVH, intraventricular hemorrhage; IUGR, intrauterine growth restriction; RBC, red blood cell.

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