Browse > Article

Development of Periventricular Leukomalacia and Severe Intraventricular Hemorrhage in Very Low Birth Weight Newborns and Relationship with Ventilator Care (Study of Ventilator Care as a Risk Factor of PVL and PV-IVH)  

Lee, Hak Sung (Department of Pediatrics, Taegu Fatima Hospital)
Lee, Sae Kyu (Department of Pediatrics, Taegu Fatima Hospital)
Kim, Yeong Jin (Department of Pediatrics, Taegu Fatima Hospital)
Lee, Sang Geel (Department of Pediatrics, Taegu Fatima Hospital)
Publication Information
Clinical and Experimental Pediatrics / v.48, no.12, 2005 , pp. 1330-1336 More about this Journal
Abstract
Purpose : It has been suggested that changes in cerebral blood flow by ventilator care could be a risk factor in periventricular leukomalacia(PVL) and severe periventricular-intraventricular hemorrhage(PV-IVH). The study aims to assess the relationship between perinatal clinical events, including ventilator care, and the development of PVL and severe PV-IVH; especially, whether ventilator care could be causers of PVL and severe PV-IVH as an individual risk factor. Methods : Among 255 very low birth weight infants who survived in the Fatima neonatal intensive care unit from January 1999 to December 2003, 15 infants with PVL and eight infants with severe PV-IVH were classified as a study group, while 231 infants were enrolled as a control group. The analysis was performed retrospectively with medical records. Results : Twenty four infants were diagnosed with PVL or severe PV-IVH. Asphyxia, recurrent apnea, sepsis, acidosis and ventilator care were significantly increased in the PVL goup. Asphyxia, recurrent apnea, RDS, acidosis and ventilator care were significantly increased in the severe PV-IVH group. Conclusion : Infants with PVL or severe PV-IVH may have multiple perinatal risk factors including asphyxia, recurrent apnea, sepsis, acidosis, RDS and ventilator care. Because most patients with ventilator care have multiple perinatal risk factors, ventilator care does not cause PVL and severe PV-IVH independently. Therefore, incidences of PVL and severe PV-IVH can be decreased by not only gentle ventilation, but also more professional antenatal care.
Keywords
Periventricular-intraventricular hemorrhage; Periventricular leukomalacia; Gentle ventilation;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Gresen G, Munck H, Lou H. Severe hypocarbia in preterm infants and neurodevelopmental deficit. Acta Pediatr Scand 1987;76:401-4   DOI
2 Philip AG, Allan WC, Tito AM, Wheeler LR. Intraventricular hemorrhage in preterm infants : declining incidence in the 1980s. Pediatrics 1989;84:797-801
3 Volpe JJ. Neonatal intraventricular hemorrhage. N Engl J Med 1981;304:886   DOI   ScienceOn
4 van de Bor M, Verloove-Vanhorick SP, Brand R, Keirse MJ, Ruys JH. Incidence and prediction of periventricular-intraventricular hemorrhage in very preterm infants. J Perinat Med 1987;15:333-9   DOI   PUBMED
5 Volpe JJ. Brain injury in the premature infant-current concepts of pathogenesis and prevention. Biol Neonate 1992;62: 231-42   DOI   PUBMED
6 Rice JE III, Vannucci RC, Brierley JB. The influence of immaturity on hypoxic-ischemic brain damage in the rat. Ann Neurol 1981;9:131-41   DOI   ScienceOn
7 Bejar RF, Vaucher YE, Benirschke K, Berry CC. Postnatal white matter necrosis in preterm infant. J Perinatol 1992; 12:3-8
8 Wiswell TE, Graziani LJ, Kornhauser MS, Stanley C, Merton DA, McKee L, et al. Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high-freqeuncy jet ventilation. Pediatrics 1996;98:918-24
9 Perlman JM. Intraventricular hemorrhage. Pediatrics 1989; 84:913-4
10 Perlman JM, Rollins N. Surveillance protocol for the detection of intracranial abnormalities in premature neonates. Arch Pediatr Adolesc Med 2000;154:822-6   DOI
11 Mark CM, Stephen JB. High frequency ventilation. Assisted ventilation of the neonate. 3rd ed. Philadelphia : WB Saunders Co, 1996;199-214
12 Okumura A, Hayakawa F, Kato T, Itomi K, Maruyama K, Ishihara N, et al. Hypocarbia in preterm infants with periventricular leukomalacia : the relation between hypocarbia and mechanical ventilation. Pediatrics 2001;107:469-75   DOI   ScienceOn
13 Clark RH. High frequency ventilation. J Pediatr 1994;124: 661-70   DOI   PUBMED   ScienceOn
14 Gannon CM, Wiswell TE, Spitzer AR. Volutrauma, PaCO2 levels, and neurodevelopmental sequelae following assisted ventilation. Clin Perinatol 1998;25:159-75
15 Hansen NB, Brubakk AM, Bratlid D, William OH, Stonetreet BS. The effects of variation in $PaCO_2$ on brain blood flow and cardiac output in the newborn piglet. Pediatr Res 1984;18:1132-6   DOI   ScienceOn
16 Leviton A, Paneth N, Reuss ML. Maternal inefection, fetal inflammatory response, and brain damage in very low birth weight infants. Pediatr Res 1999;46:566-75   DOI   ScienceOn
17 Calvert SA, Hoskins EM, Fong KW, Forsyth SC. Etiologic factors associated with the development of periventricular leukomalacia. Acta Pediatr Scand 1987;76:254-9   DOI
18 Young RSK, Hernandez MJ, Yagel SK. Selective reduction of blood flow to white matter during hypotention in newborn dogs. A possible mechanism of periventricular leukomalacia. Ann Neruol 1982;12:445-52   DOI   ScienceOn
19 Tarby TJ, Volpe JJ. Intraventricular hemorrhage in the premature infant. Pediatr Clin North Am 1982;29:1077-104   DOI
20 Strauss A, Kirz D, Mandalou HD, Freeman RK. Perinatal events and intraventricular$_{}$ependymal hemorrhage in the very low-birth weight infant. Am J Obstet Gynecol 1985;151:1022-7   DOI
21 Graziani LJ, Spitzer AR, Mitchell DG, Merton DA, Stanley C, Robinson N. Mechanical ventilation in preterm infants : neurosonographic and development studies. Pediatrics 1992; 90:515-21
22 Perlman JM. White matter injury in the preterm infant : an important determination of abnormal neurodevelopment outcome. Early Hum Dev 1998;53:99-120   DOI   PUBMED   ScienceOn
23 Perlman JM, Risser R, Broyles RS. Bilateral cystic periventricular leukomalacia in the premature infant : associated risk factors. Pediatrics 1996;97:822-7
24 Tavares EC, Correa FF, Viana MB. Risk factors to periventricular- intraventricular hemorrhage in newborns weighing less than 2000 g. J Pediatr 1998;74:17-24   DOI
25 Cavazzutti M, Duffy TE. Regulation of cerebral blood flow in normal and hypoxic newborn dogs. Ann Neurol 1982;11: 247-54   DOI   ScienceOn
26 Collins MP, Lorenz JM, Jetton JR, Paneth N. Hypocarpnia and other ventilation-related risk factors for cerebral palsy in low birth weight infants. Pediatr Res 2001;50:712-9   DOI   ScienceOn
27 Perlman JM, Rollins N, Burns D, Risser Rick. Relationship between periventricular intraparenchymal echodensities and germinal matrix-intraventricular hemorrhage in the very low birth weight neonate. Pediatrics 1993;91:474-80
28 Schman RM, Selednik LJ. Periventricular leukomalacia : a one-year autopsy study. Arch Neurol 1980;37:231-5.ms-e   DOI   ScienceOn
29 Wung JT. Mechanical ventilation of the newborn. Respiratory care for the newborn. 9th ed. Columbia : Presbyterian Medical Center, 1996:9-33
30 Stranak Z, Velebil P, Mechurova A. Influence of antenatal steroids on perinatal mortality and morbidity in extremely low birth weight. Sb Lek 2003;104:345-52
31 Perlman JM. White matter injury in the preterm infant : an important determinant of abnormal neurodevelopmental outcome. Early Human Dev 1998;53:99-120   DOI   PUBMED   ScienceOn
32 Verder H, Robertson B, Greisen G. Surfactant treatment and nasal continuous positive airway pressure for newborn with respiratory distress syndrome. N Engl J Med 1994; 331:1051-64   DOI   ScienceOn
33 Bass WT, Kopelman AE. Central nervous system morbidity. In : Goldsmith JP, Karotkin EH, editors. Assisted ventilation of the neonate. 4th ed. Philadelphia : Saunders, 2003:429-48
34 Pryds O. Control of cerebral circulation in the high-risk neonate. Ann Neurol 1997;30:321-9   DOI   PUBMED   ScienceOn
35 Jambleton G, Wiggelsworth JS. Origin of intraventricular hemorrhage in the preterm infant. Arch Dis Child 1976;57: 651-5
36 Perlman JM, Risser R, Broyles RS. Bilateral cystic periventricular leukomalacia in premature infant : associated risk factors. American Academy of Pediatrics 1996;97:822-7
37 Garland JS, Buck R, Leviton A. Effect of maternal glucocorticoid exposure on risk of severe intraventricular hemorrhage in surfactant-treated preterm infants. J Pediatr 1995;126:272-93-6   DOI   PUBMED   ScienceOn
38 Preds O, Greisen G, Lou H, Friis-Hansen B. Heterogeneity of cerebral vasoreactivity in preterm infants supported by mechanical ventilation. J Pediatr 1989;115:638-45   DOI   PUBMED
39 Wung JT. Continuous positive airway pressure. Respiratory care for the newborn. 9th ed. Columbia : Presbyterian Medical Center, 1996:1-8
40 Levene MI, Fawer CL, Lamont RF. Risk factors in the development of intraventricular haemorrhage in the preterm neonate. Arch Dis Child 1982;57:410-7   DOI   ScienceOn