Pediatric Periventricular Leukomalacia Clinical Presentation

Updated: Jan 15, 2015
  • Author: Terence Zach, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Presentation

History

Periventricular leukomalacia (PVL) occurs most commonly in premature infants born at less than 32 weeks' gestation who have a birth weight of less than 1500 g. Many of these infants have a history of maternal chorioamnionitis. Most affected infants experience cardiorespiratory problems, such as respiratory distress syndrome or pneumonia, in association with hypotension or patent ductus arteriosus during their first days of life. Bacterial infection at birth also appears to be a risk factor.

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Physical

Initially, most premature infants are asymptomatic. If symptoms occur, they are usually subtle. Symptoms may include the following:

  • Decreased tone in lower extremities
  • Increased tone in neck extensors
  • Apnea and bradycardia events
  • Irritability
  • Pseudobulbar palsy with poor feeding
  • Clinical seizures (may occur in 10-30% of infants)
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Causes

Mechanically ventilated premature infants born at less than 32 weeks' gestation are at greatest risk for periventricular leukomalacia.

Hypotension, hypoxemia, and acidosis may result in ischemic brain injury and periventricular leukomalacia.

Marked hypocarbia in ventilated premature infants has been associated with increased risk of developing periventricular leukomalacia.

Other associated risk factors include the following:

  • Placental vascular anastomoses, twin gestation, antepartum hemorrhage
  • Chorioamnionitis and funisitis
  • Sepsis
  • Maternal cocaine abuse
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