Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. 2111-2118 (doi:10.1542/peds.2005-1570)

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Ultrasonographic Features and Severity Scoring of Periventricular Hemorrhagic Infarction in Relation to Risk Factors and Outcome

Haim Bassan, MD^a, Carol B. Benson, MD^b, Catherine Limperopoulos, PhD^a, Henry A. Feldman, PhD^c, Steven A. Ringer, MD, PhD^d, Elaine Veracruz^a, Jane E. Stewart, MD^e, Janet S. Soul, MD^a, Donald N. DiSalvo, MD^b, Joseph J. Volpe, MD^a and Adré J. du Plessis, MBChB, MPH^a

^a Fetal/Neonatal Neurology Research Group, Department of Neurology
^c Clinical Research Program, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
^b Radiology
^d Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
^e Department of Newborn Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts

OBJECTIVE. Early diagnosis of periventricular hemorrhagic infarction in premature infants is based on bedside neonatal cranial ultrasonography. Currently, evaluation of its morphology and evolution by cranial ultrasound relies largely on data predating major advances in perinatal care and lacks a consistent classification system for determining severity of injury. The objective of this study was to examine the ultrasonographic morphology and evolution of periventricular hemorrhagic infarction in the modern NICU and to determine the value of a cranial ultrasonography-based severity score for predicting outcome.

METHODS. We retrospectively evaluated all cranial ultrasounds and medical records of 58 premature infants with periventricular hemorrhagic infarction. We assigned each subject a severity score based on extent of echodensity, unilateral versus bilateral, and presence or absence of midline shift. A neurologic examination was performed after 12 months adjusted age.

RESULTS. The parenchymal echodensity of periventricular hemorrhagic infarction most often involved parietal and frontal territories and evolved into single and/or multiple cysts. One quarter of cases were bilateral, and nearly 70% were extensive. Higher severity scores were significantly associated with pulmonary hemorrhage and low bicarbonate levels and with outcomes of fatality, early neonatal seizures, and motor disability.

CONCLUSIONS. Despite advances in perinatal medicine, periventricular hemorrhagic infarction remains an important complication of prematurity. Periventricular hemorrhagic infarction can be graded using a scoring system based on sonographic characteristics. Higher severity scores predict worse outcome. Such severity scoring could improve the clinician's ability to counsel parents regarding management decisions and early intervention strategies.

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Key Words: ultrasonography • periventricular hemorrhagic infarction • grade IV intraventricular hemorrhage • premature infants

Abbreviations: PVHI—periventricular hemorrhagic infarction • GM-IVH—germinal matrix–intraventricular hemorrhage • CUS—cranial ultrasonography • PVL—periventricular leukomalacia

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Accepted Nov 17, 2005.

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Do Higher Cranial Ultrasound Severity Scores Really Predict Worse Outcome?

Fattma Abdel-Salam, et al.

Pediatrics Online, 22 Jun 2006 [Full text]