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Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1996 Jul;75(1):F27–F32. doi: 10.1136/fn.75.1.f27

Clinical associations and time of onset of cerebral white matter damage in very preterm babies.

D J Murphy 1, M V Squier 1, P L Hope 1, S Sellers 1, A Johnson 1
PMCID: PMC1061146  PMID: 8795352

Abstract

Neuropathological examinations were carried out at necropsy on 83 very pre-term babies who died during their first hospital admission. Forty seven (57%) babies had evidence of cerebral damage-39 with ischaemic white matter damage. The time of onset of ischaemic lesions was thought to be prenatal in 12 cases (31%) and postnatal in a further 12 (31%). The exact timing of damage could not be determined in 15 (38%) cases. Maternal and neonatal case notes were reviewed to ascertain clinical associations of ischaemic white matter damage. There were no clear associations between adverse clinical factors and prenatal ischaemic white matter damage. In contrast, pre-eclampsia, intrauterine growth retardation, and delivery without labour were associated with postnatal damage as were neonatal sepsis, necrotising enterocolitis, and seizures. The absence of a clear association between the timing of adverse clinical factors and the timing of ischaemic cerebral damage suggests that cerebral damage in very preterm babies may result from a sequence of events rather than one specific insult.

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Selected References

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  1. Bejar R., Wozniak P., Allard M., Benirschke K., Vaucher Y., Coen R., Berry C., Schragg P., Villegas I., Resnik R. Antenatal origin of neurologic damage in newborn infants. I. Preterm infants. Am J Obstet Gynecol. 1988 Aug;159(2):357–363. doi: 10.1016/s0002-9378(88)80084-x. [DOI] [PubMed] [Google Scholar]
  2. Cooke R. W. Early and late cranial ultrasonographic appearances and outcome in very low birthweight infants. Arch Dis Child. 1987 Sep;62(9):931–937. doi: 10.1136/adc.62.9.931. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Ellis W. G., Goetzman B. W., Lindenberg J. A. Neuropathologic documentation of prenatal brain damage. Am J Dis Child. 1988 Aug;142(8):858–866. doi: 10.1001/archpedi.1988.02150080064025. [DOI] [PubMed] [Google Scholar]
  4. Fawer C. L., Diebold P., Calame A. Periventricular leucomalacia and neurodevelopmental outcome in preterm infants. Arch Dis Child. 1987 Jan;62(1):30–36. doi: 10.1136/adc.62.1.30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Gaffney G., Squier M. V., Johnson A., Flavell V., Sellers S. Clinical associations of prenatal ischaemic white matter injury. Arch Dis Child Fetal Neonatal Ed. 1994 Mar;70(2):F101–F106. doi: 10.1136/fn.70.2.f101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Graham M., Levene M. I., Trounce J. Q., Rutter N. Prediction of cerebral palsy in very low birthweight infants: prospective ultrasound study. Lancet. 1987 Sep 12;2(8559):593–596. doi: 10.1016/s0140-6736(87)92986-2. [DOI] [PubMed] [Google Scholar]
  7. Leviton A., Paneth N. White matter damage in preterm newborns--an epidemiologic perspective. Early Hum Dev. 1990 Oct;24(1):1–22. doi: 10.1016/0378-3782(90)90002-z. [DOI] [PubMed] [Google Scholar]
  8. Mallard E. C., Williams C. E., Gunn A. J., Gunning M. I., Gluckman P. D. Frequent episodes of brief ischemia sensitize the fetal sheep brain to neuronal loss and induce striatal injury. Pediatr Res. 1993 Jan;33(1):61–65. doi: 10.1203/00006450-199301000-00013. [DOI] [PubMed] [Google Scholar]
  9. Murphy D. J., Sellers S., MacKenzie I. Z., Yudkin P. L., Johnson A. M. Case-control study of antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies. Lancet. 1995 Dec 2;346(8988):1449–1454. doi: 10.1016/s0140-6736(95)92471-x. [DOI] [PubMed] [Google Scholar]
  10. Nelson K. B., Grether J. K. Can magnesium sulfate reduce the risk of cerebral palsy in very low birthweight infants? Pediatrics. 1995 Feb;95(2):263–269. [PubMed] [Google Scholar]
  11. Pharoah P. O., Cooke T., Cooke R. W., Rosenbloom L. Birthweight specific trends in cerebral palsy. Arch Dis Child. 1990 Jun;65(6):602–606. doi: 10.1136/adc.65.6.602. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Scher M. S., Belfar H., Martin J., Painter M. J. Destructive brain lesions of presumed fetal onset: antepartum causes of cerebral palsy. Pediatrics. 1991 Nov;88(5):898–906. [PubMed] [Google Scholar]
  13. Sims M. E., Turkel S. B., Halterman G., Paul R. H. Brain injury and intrauterine death. Am J Obstet Gynecol. 1985 Mar 15;151(6):721–723. doi: 10.1016/0002-9378(85)90503-4. [DOI] [PubMed] [Google Scholar]
  14. Sinha S. K., D'Souza S. W., Rivlin E., Chiswick M. L. Ischaemic brain lesions diagnosed at birth in preterm infants: clinical events and developmental outcome. Arch Dis Child. 1990 Oct;65(10 Spec No):1017–1020. doi: 10.1136/adc.65.10_spec_no.1017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Squier M., Keeling J. W. The incidence of prenatal brain injury. Neuropathol Appl Neurobiol. 1991 Feb;17(1):29–38. doi: 10.1111/j.1365-2990.1991.tb00691.x. [DOI] [PubMed] [Google Scholar]
  16. Weindling A. M., Rochefort M. J., Calvert S. A., Fok T. F., Wilkinson A. Development of cerebral palsy after ultrasonographic detection of periventricular cysts in the newborn. Dev Med Child Neurol. 1985 Dec;27(6):800–806. doi: 10.1111/j.1469-8749.1985.tb03805.x. [DOI] [PubMed] [Google Scholar]
  17. de Vries L. S., Dubowitz L. M., Dubowitz V., Kaiser A., Lary S., Silverman M., Whitelaw A., Wigglesworth J. S. Predictive value of cranial ultrasound in the newborn baby: a reappraisal. Lancet. 1985 Jul 20;2(8447):137–140. doi: 10.1016/s0140-6736(85)90237-5. [DOI] [PubMed] [Google Scholar]

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