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Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1998 Jan;78(1):F51–F56. doi: 10.1136/fn.78.1.f51

Antenatal onset of haemorrhagic and/or ischaemic lesions in preterm infants: prevalence and associated obstetric variables

L S de Vries, P Eken, F Groenendaal, K Rademaker, B Hoogervorst, H Bruinse
PMCID: PMC1720739  PMID: 9536842

Abstract

AIM—To assess the prevalence of an antenatal onset of haemorrhagic and/or ischaemic lesions in preterm infants; to identify possibly related obstetric risk factors.
METHODS—A prospective cohort study was made of 1332 infants born at less than 34 completed weeks, using cranial ultrasound, for the presence of antenatal brain lesions (group A) involving the periventricular white matter (PVWM) or central grey matter. Entry criteria were presence of (i) cysts in the PVWM < 7 days; (ii) increased PVWM echogenicity < 6 hours, confirmed to be white matter necrosis at post mortem examination; (iii) a unilateral porencephalic cyst< 3 days; (iv) an intraventricular haemorrhage with unilateral parenchymal involvement < 6 hours; and (v) symmetrical areas of increased echogenicity in the thalami, confirmed to be areas of calcification on post mortem examination. Group B consisted of infants with a normal early neonatal ultrasound scan with subsequent development of the lesions mentioned above.
RESULTS—Twenty four cases met the entry criteria for group A: 17 died and five of the seven survivors developed cerebral palsy at follow up. Of the whole cohort, 156 (11.7%) infants died and in 63 (40.3%) of these a large ultrasound lesion was present. In 17 (26.9%) cases this lesion was considered to be of antenatal onset. Sixty eight of the 1176 (5.8%) survivors developed cerebral palsy and this was attributed to antenatal onset in five (7.3%). A comparison of the obstetric risk factors between the infants in group A and B, who either died or developed cerebral palsy, showed a significant difference in gestational age between the two groups (30.9 vs 28.9 weeks; p<0.001). Prolonged rupture of membranes was significantly more common in group B (p=0.03), while an ominous cardiotachogram was significantly more common in group A (p=0.01), and this remained significant following logistic regression analysis.
CONCLUSIONS—Although these data suggest that most preterm infants did not develop their brain lesions in utero, an antenatal onset was not uncommon, especially in those with PVWM lesions, who did not survive the neonatal period.



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Selected References

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  1. Baethmann M., Kahn T., Lenard H. G., Voit T. Fetal CNS damage after exposure to maternal trauma during pregnancy. Acta Paediatr. 1996 Nov;85(11):1331–1338. doi: 10.1111/j.1651-2227.1996.tb13920.x. [DOI] [PubMed] [Google Scholar]
  2. 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]
  3. Blair E., Stanley F. J. Intrapartum asphyxia: a rare cause of cerebral palsy. J Pediatr. 1988 Apr;112(4):515–519. doi: 10.1016/s0022-3476(88)80161-6. [DOI] [PubMed] [Google Scholar]
  4. Boesch C., Issakainen J., Kewitz G., Kikinis R., Martin E., Boltshauser E. Magnetic resonance imaging of the brain in congenital cytomegalovirus infection. Pediatr Radiol. 1989;19(2):91–93. doi: 10.1007/BF02387893. [DOI] [PubMed] [Google Scholar]
  5. Burke C. J., Tannenberg A. E. Prenatal brain damage and placental infarction--an autopsy study. Dev Med Child Neurol. 1995 Jun;37(6):555–562. doi: 10.1111/j.1469-8749.1995.tb12042.x. [DOI] [PubMed] [Google Scholar]
  6. Eicke M., Briner J., Willi U., Uehlinger J., Boltshauser E. Symmetrical thalamic lesions in infants. Arch Dis Child. 1992 Jan;67(1 Spec No):15–19. doi: 10.1136/adc.67.1_spec_no.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fogarty K., Cohen H. L., Haller J. O. Sonography of fetal intracranial hemorrhage: unusual causes and a review of the literature. J Clin Ultrasound. 1989 Jun;17(5):366–370. doi: 10.1002/jcu.1870170510. [DOI] [PubMed] [Google Scholar]
  8. 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]
  9. Hagberg G., Hagberg G., Olow I. The changing panorama of cerebral palsy in Sweden 1954-1970. II. Analysis of the various syndromes. Acta Paediatr Scand. 1975 Mar;64(2):193–200. doi: 10.1111/j.1651-2227.1975.tb03821.x. [DOI] [PubMed] [Google Scholar]
  10. Larroche J. C., Droullé P., Delezoide A. L., Narcy F., Nessmann C. Brain damage in monozygous twins. Biol Neonate. 1990;57(5):261–278. doi: 10.1159/000243201. [DOI] [PubMed] [Google Scholar]
  11. Mercer B. M., Arheart K. L. Antimicrobial therapy in expectant management of preterm premature rupture of the membranes. Lancet. 1995 Nov 11;346(8985):1271–1279. doi: 10.1016/s0140-6736(95)91868-x. [DOI] [PubMed] [Google Scholar]
  12. Murdoch Eaton D. G., Ahmed Y., Dubowitz L. M. Maternal trauma and cerebral lesions in preterm infants. Case reports. Br J Obstet Gynaecol. 1991 Dec;98(12):1292–1294. doi: 10.1111/j.1471-0528.1991.tb15406.x. [DOI] [PubMed] [Google Scholar]
  13. Murphy D. J., Hope P. L., Johnson A. Ultrasound findings and clinical antecedents of cerebral palsy in very preterm infants. Arch Dis Child Fetal Neonatal Ed. 1996 Mar;74(2):F105–F109. doi: 10.1136/fn.74.2.f105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. 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]
  15. Murphy D. J., Squier M. V., Hope P. L., Sellers S., Johnson A. Clinical associations and time of onset of cerebral white matter damage in very preterm babies. Arch Dis Child Fetal Neonatal Ed. 1996 Jul;75(1):F27–F32. doi: 10.1136/fn.75.1.f27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Nelson K. B., Leviton A. How much of neonatal encephalopathy is due to birth asphyxia? Am J Dis Child. 1991 Nov;145(11):1325–1331. doi: 10.1001/archpedi.1991.02160110117034. [DOI] [PubMed] [Google Scholar]
  17. Perlman J. M., Risser R., Broyles R. S. Bilateral cystic periventricular leukomalacia in the premature infant: associated risk factors. Pediatrics. 1996 Jun;97(6 Pt 1):822–827. [PubMed] [Google Scholar]
  18. Pinto-Martin J. A., Riolo S., Cnaan A., Holzman C., Susser M. W., Paneth N. Cranial ultrasound prediction of disabling and nondisabling cerebral palsy at age two in a low birth weight population. Pediatrics. 1995 Feb;95(2):249–254. [PubMed] [Google Scholar]
  19. 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]
  20. 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]
  21. Spinillo A., Capuzzo E., Stronati M., Ometto A., Orcesi S., Fazzi E. Effect of preterm premature rupture of membranes on neurodevelopmental outcome: follow up at two years of age. Br J Obstet Gynaecol. 1995 Nov;102(11):882–887. doi: 10.1111/j.1471-0528.1995.tb10875.x. [DOI] [PubMed] [Google Scholar]
  22. 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]
  23. de Vries L. S., Connell J., Bydder G. M., Dubowitz L. M., Rodeck C. H., Mibashan R. S., Waters A. H. Recurrent intracranial haemorrhages in utero in an infant with alloimmune thrombocytopenia. Case report. Br J Obstet Gynaecol. 1988 Mar;95(3):299–302. doi: 10.1111/j.1471-0528.1988.tb06873.x. [DOI] [PubMed] [Google Scholar]
  24. 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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