Episodes of hypocarbia and early-onset sepsis are risk factors for cystic periventricular leukomalacia in the preterm infant

• Published in: Early human development Vol. 88; no. 1; pp. 27 - 31
• Main Authors: Resch, B., Neubauer, K., Hofer, N., Resch, E., Maurer, U., Haas, J., Müller, W.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.01.2012; Elsevier
• Subjects: Advanced Basic Science; Age; Apgar Score; Biological and medical sciences; Birth weight; Case-Control Studies; Early-onset sepsis; Embryology: invertebrates and vertebrates. Teratology; Female; Fundamental and applied biological sciences. Psychology; Gender; Gestational Age; Humans; Hypocapnia - complications; Hypocapnia - diagnosis; Hypocarbia; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - diagnosis; Infant, Premature, Diseases - diagnostic imaging; Infants; Leukomalacia, Periventricular - complications; Leukomalacia, Periventricular - diagnosis; Leukomalacia, Periventricular - diagnostic imaging; Logistic Models; Male; Multivariate analysis; Neonatal and Perinatal Medicine; Neonatal Screening - methods; Neonates; Neurodevelopmental outcome; Periventricular leukomalacia; Preterm infant; Regression analysis; Respiratory distress syndrome; Retrospective Studies; Risk Factors; Seizures; Sepsis; Sepsis - complications; Steroid hormones; steroids; Surfactants; Ultrasonography; Ultrasound; Preterm infant; Periventricular leukomalacia; Neurodevelopmental outcome; Hypocarbia; Early-onset sepsis; Human; Cerebral infarction; Nervous system diseases; Cardiovascular disease; Cerebral disorder; Infection; Vascular disease; Sepsis syndrome; Prematurity; Central nervous system disease; Risk factor; Early; Cerebrovascular disease
• ISSN: 0378-3782; 1872-6232; 1872-6232
• DOI: 10.1016/j.earlhumdev.2011.06.011

Septic episodes in preterm infants recently have been reported to be associated with periventricular leukomalacia (PVL). The role of hypocarbia as an independent risk factor for PVL in clinical studies raises many questions without conclusive answers. To evaluate risk factors for cystic PVL focussing on the influence of hypocarbia. Retrospective single centre case-control study. Preterm infants 24 to 35weeks of gestational age and matched (1:2 for gender, birth year, gestational age and birth weight) controls. Multivariate analysis of perinatal factors being associated with cystic PVL diagnosed by serial ultrasound examinations. Univariate analysis of risk factors revealed lower 5 and 10min Apgar scores, and higher rates of neonatal seizures, early-onset sepsis, neonatal steroids, respiratory distress syndrome with surfactant replacement therapy, and episodes of hypocarbia significantly being associated with PVL. Multivariate analysis using a logistic regression model revealed early-onset sepsis and hypocarbia being significantly associated with PVL (p=.022 and .024, respectively). Lowest PaCO2 values did not differ as did not the duration of hypocarbia, but the onset of hypocarbia was significantly later in PVL cases compared to controls (mean 26 vs. 15h, p=.033). Neurodevelopmental follow-up at a median time of 46months was poor showing 88% of the cases having an adverse neurological outcome. We found early-onset sepsis and episodes of hypocarbia within the first days of life being independently associated with PVL. ► Besides preterm premature rupture of the membranes and chorioamnionitis early-onset sepsis remains an additional risk factor fort he development of cystic PVL. ► The association between hypocarbia and PVL is stringent. However, the individual risk assessment is difficult in clinical routine. ► Neurodevelopmental follow-up of infants with cystic PVL reveals adverse neurological outcome in the majority of infants.