eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Periventricular Leukomalacia: Follow-up

Author: Terence Zach, MD, Department Vice-Chair, Professor, Department of Pediatrics, Section of Newborn Medicine, Creighton University
Coauthor(s): James C Brown, MD, Codirector of Pediatric Radiology, Assistant Professor, Department of Radiology, Creighton University School of Medicine
Contributor Information and Disclosures

Updated: Feb 14, 2008

Follow-up

Further Outpatient Care

  • Developmental follow-up: Premature infants with evidence of periventricular leukomalacia (PVL) require close developmental follow-up because of the high association with CP. 
  • Early intervention strategies carried out by occupational therapists or physical therapists may decrease symptoms and may increase the infant's motor function.

Deterrence/Prevention

  • Prevention of premature birth is the most important means of preventing PVL.
  • Prior to birth, diagnosing and managing chorioamnionitis may prevent PVL. In 1999, Baud et al reported that betamethasone administered to mothers at 24-31 weeks' gestation, before delivery, significantly reduced the risk of PVL, suggesting the possible effect of steroids on fetal inflammatory response.4,5
  • Avoiding maternal cocaine abuse and avoiding maternal-fetal blood flow alterations has been suggested to minimize PVL.
  • Following delivery of a premature infant, attempts to minimize blood pressure (BP) swings and hypotension may also be beneficial in preventing PVL.
  • Avoidance of prolonged hypocarbia in the mechanically ventilated premature infant may be useful in the prevention of PVL.

Prognosis

  • Infants with PVL are at risk for development of neurodevelopmental deficits. Mild PVL is often associated with spastic diplegia. Severe PVL is associated with quadriplegia. Severe PVL is also associated with a higher incidence of intelligence deficiencies and visual disturbances.

Miscellaneous

Medicolegal Pitfalls

  • Timing of initial cranial ultrasonography can be useful in determining the timing of the insult. Cystic PVL has been identified on cranial ultrasounds on the first day of life, indicating that the event was prenatal rather than perinatal or postnatal.
 


More on Periventricular Leukomalacia

Overview: Periventricular Leukomalacia
Differential Diagnoses & Workup: Periventricular Leukomalacia
Treatment & Medication: Periventricular Leukomalacia
Follow-up: Periventricular Leukomalacia
Multimedia: Periventricular Leukomalacia
References
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References

  1. Okumura A, Hayakawa F, Kato T, et al. Hypocarbia in preterm infants with periventricular leukomalacia: the relation between hypocarbia and mechanical ventilation. Pediatrics. Mar 2001;107(3):469-75. [Medline]. [Full Text].

  2. Wiswell TE, Graziani LJ, Kornhauser MS, et al. Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high-frequency jet ventilation. Pediatrics. Nov 1996;98(5):918-24. [Medline].

  3. Kaukola T, Herva R, Perhomaa M, et al. Chorioamnionitis and cord serum proinflammatory cytokines: lack of association with brain damage and neurologic outcomes in very preterm infants. Pediatr Res. 2005;[Medline].

  4. Baud O, Foix-L'Helias L, Kaminski M, et al. Antenatal glucocorticoid treatment and cystic periventricular leukomalacia in very premature infants. N Engl J Med. Oct 14 1999;341(16):1190-6. [Medline].

  5. Canterino JC, Verma U, Visintainer PF, et al. Antenatal steroids and neonatal periventricular leukomalacia. Obstet Gynecol. Jan 2001;97(1):135-9. [Medline].

  6. Bass WT, Jones MA, White LE, et al. Ultrasonographic differential diagnosis and neurodevelopmental outcome of cerebral white matter lesions in premature infants. J Perinatol. Jul-Aug 1999;19(5):330-6. [Medline].

  7. Baud O, d'Allest AM, Lacaze-Masmonteil T, et al. The early diagnosis of periventricular leukomalacia in premature infants with positive rolandic sharp waves on serial electroencephalography. J Pediatr. May 1998;132(5):813-7. [Medline].

  8. Dammann O, Hagberg H, Leviton A. Is periventricular leukomalacia an axonopathy as well as an oligopathy?. Pediatr Res. Apr 2001;49(4):453-7. [Medline]. [Full Text].

  9. Dammann O, Leviton A. Brain damage in preterm newborns: might enhancement of developmentally regulated endogenous protection open a door for prevention?. Pediatrics. Sep 1999;104(3 Pt 1):541-50. [Medline]. [Full Text].

  10. de Vries LS, Regev R, Dubowitz LM, et al. Perinatal risk factors for the development of extensive cystic leukomalacia. Am J Dis Child. Jul 1988;142(7):732-5. [Medline].

  11. De Vries LS, Van Haastert IL, Rademaker KJ, et al. Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants. J Pediatr. Jun 2004;144(6):815-20. [Medline].

  12. Enzmann DR. Imaging of neonatal hypoxic-ischemic cerebral damage. In: Stevenson DK, Sunshine P, eds. Fetal and Neonatal Brain Injury: Mechanisms, Management, and the Risk of Practice. 2nd ed. Oxford, England: Oxford University Press; 1997:302-55.

  13. Hahn JS, Novotony EJ Jr. Hypoxic-ischemic encephalopathy. In: Stevenson DK, Sunshine P, eds. Fetal and Neonatal Brain Injury: Mechanisms, Management, and the Risk of Practice. 2nd ed. Oxford, England:. Oxford University Press;1997:277-286.

  14. Hayakawa F, Okumura A, Kato T, et al. Determination of timing of brain injury in preterm infants with periventricular leukomalacia with serial neonatal electroencephalography. Pediatrics. Nov 1999;104(5 Pt 1):1077-81. [Medline]. [Full Text].

  15. Haynes RL, Baud O, Li J, et al. Oxidative and nitrative injury in periventricular leukomalacia: a review. Brain Pathol. 2005;15:225-233. [Medline].

  16. Kuban K, Sanocka U, Leviton A, et al. White matter disorders of prematurity: association with intraventricular hemorrhage and ventriculomegaly. The Developmental Epidemiology Network. J Pediatr. May 1999;134(5):539-46. [Medline].

  17. Leviton A, Paneth N, Reuss ML, et al. Maternal infection, fetal inflammatory response, and brain damage in very low birth weight infants. Developmental Epidemiology Network Investigators. Pediatr Res. Nov 1999;46(5):566-75. [Medline].

  18. Liao SL, Lai SH, Chou YH, Kuo CY. Effect of hypocapnia in the first three days of life on the subsequent development of periventricular leukomalacia in premature infants. Acta Paediatr Taiwan. Mar-Apr 2001;42(2):90-3. [Medline].

  19. Murata Y, Itakura A, Matsuzawa K, et al. Possible antenatal and perinatal related factors in development of cystic periventricular leukomalacia. Brain Dev. 2005;27:17-21. [Medline].

  20. Paul DA, Pearlman SA, Finkelstein MS, Stefano JL. Cranial sonography in very-low-birth-weight infants: do all infants need to be screened?. Clin Pediatr (Phila). Sep 1999;38(9):503-9. [Medline].

  21. Shankaran S. Hemorrhagic lesions of the central nervous system. In: Stevenson DK, Sunshine P, eds. Fetal and Neonatal Brain Injury: Mechanisms, Management, and the Risk of Practice. 2nd ed. Oxford, England: Oxford University Press; 1997:151-64.

  22. Volpe JJ. Brain injury in the premature infant: overview of clinical aspects, neuropathology, and pathogenesis. Semin Pediatr Neurol. Sep 1998;5(3):135-51. [Medline].

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Further Reading

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Keywords

periventricular leukomalacia, PVL, ischemic brain injury, cerebral palsy, CP, hypotension, ischemia, coagulation necrosis, intracranial hemorrhage, ICH, hypocarbia, vasculitis, chorioamnionitis, cytokines, white matter damage, spastic diplegia, quadriplegia, nystagmus, strabismus, blindness, retinopathy of prematurity, maternal chorioamnionitis, respiratory distress syndrome, pneumonia, patent ductus arteriosus, placental vascular anastomoses, twin gestation, antepartum hemorrhage, sepsis

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Contributor Information and Disclosures

Author

Terence Zach, MD, Department Vice-Chair, Professor, Department of Pediatrics, Section of Newborn Medicine, Creighton University
Terence Zach, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Nebraska Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

James C Brown, MD, Codirector of Pediatric Radiology, Assistant Professor, Department of Radiology, Creighton University School of Medicine
James C Brown, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Radiology, American Medical Association, and Nebraska Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Scott S MacGilvray, MD, Associate Professor, Department of Pediatrics, East Carolina University School of Medicine
Scott S MacGilvray, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Arun K Pramanik, MD, MBBS, Professor of Pediatrics, Director of Neonatal Fellowship, Louisiana State University Health Sciences Center
Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Carol L Wagner, MD, Professor of Pediatrics, Medical University of South Carolina
Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD, Head, Division of Neonatal-Perinatal Medicine, Professor, Departments of Pediatrics and Obstetrics/Gynecology, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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