Published online January 4, 2006
PEDIATRICS Vol. 117 No. 1 January 2006, pp. 1-8 (doi:10.1542/peds.2004-1719)

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ARTICLE

Hemodynamics of the Cerebral Arteries of Infants With Periventricular Leukomalacia

Sumio Fukuda, MD, Takenori Kato, MD, Hiroki Kakita, MD, Yasumasa Yamada, MD, Mohamed Hamed Hussein, MD, Ineko Kato, MD, Satoshi Suzuki, MD and Hajime Togari, MD

Department of Pediatrics, Neonatology, and Congenital Disorders, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan

OBJECTIVE. This study investigated the developmental changes in blood flow in each cerebral artery among infants with and without periventricular leukomalacia (PVL), to elucidate the time of onset of PVL.

METHODS. Eight of 67 low birth weight infants were diagnosed through ultrasonography as having PVL with cyst formation. The mean cerebral blood flow velocities (CBFVs) in the anterior cerebral artery, middle cerebral arteries (MCAs), posterior cerebral arteries (PCAs), internal carotid arteries (ICAs), and basilar artery were measured with Doppler ultrasonography at postnatal days 0, 1, 2, 3, 4, 5, 7, 10, 14, 21, 28, 42, 56, and 70. Four of 8 infants with cyst formation and 1 of 59 infants without cyst formation developed cerebral palsy.

RESULTS. The mean CBFVs of infants with PVL were significantly lower in the anterior cerebral artery (days 14–70), the right MCA (days 14–70), the left MCA (days 14–70), the right PCA (days 7–70), the left PCA (days 5–70), the right ICA (days 7–70), the left ICA (days 7–70), and the basilar artery (days 14 and 28–70). The CBFVs in all arteries were also lower among those with PVL than among intact infants on day 0. The CBFVs increased postnatally in the PCAs of infants with intact brains, whereas they remained unchanged after day 14 or 21 among infants with PVL. There was a significant difference in the prevalence of cerebral palsy between the 2 groups.

CONCLUSIONS. We suggest that the total cerebral blood supply is decreased in cases of cystic PVL and that this reduction occurs just after birth, in a defined sequence, in the cerebral arteries. We conclude that the insult resulting in PVL might occur close to the time of birth.

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Key Words: periventricular leukomalacia • cerebral blood flow velocity • cerebral ischemia • transcranial ultrasonography

Abbreviations: PVL—periventricular leukomalacia • CBFV—cerebral blood flow velocity • PCA—posterior cerebral artery • ACA—anterior cerebral artery • MCA—middle cerebral artery • BA—basilar artery • ICA—internal carotid artery • CP—cerebral palsy

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Accepted Apr 8, 2005.

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