PEDIATRICS Vol. 85 No. 6 June 1990, pp. 1027-1033
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Periventricular-Intraventricular Hemorrhage Sonographic Localization, Phenobarbital, and Motor Abnormalities in Low Birth Weight Infants

Kalpathy S. Krishnamoorthy MD1, Karl C. K. Kuban MD1, Alan Leviton MD1, Elizabeth R. Brown MD1, Kathleen F. Sullivan RN1, and Elizabeth N. Allred MS1

1 From the Departments of Neurology and Pediatrics, Massachusetts General Hospital, The Children's Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston

A total of 228 low birth weight (less than 1750 g), mechanically ventilated infants with and without periventricular-intraventricular hemorrhage were exammed at 18 months corrected age to assess the relationship between cranial ultrasonographic findings and specific motor abnormalities. All infants were previously enrolled in a double-blind, randomized, prospective clinical trial of phenobarbital prophylaxis against periventricular-intraventricular hemorrhage. Ultrasonographic abnormalities on the scans performed between 7 and 13 days of life were categorized as germinal matrix hemorrhage, lateral ventricular hemorrhage, parenchymal hemorrhage, ventriculomegaly, and any hemorrhage. Regardless of anatomical location, periventricular-intraventricular hemorrhage was associated with an increased risk for developing motor abnormalities. Hypertonia and hyperreflexia/ankle clonus were most common. No abnormal motor findings distinguished unilateral from bilateral germinal matrix hemorrhage and lateral ventricular hemorrgage or between phenobarbital and placebo treatment. None of the 5 infants with parenchymal hemorrhage had spastic cerebral palsy. Ventriculomegaly was associated with a fivefold increase in risk for spastic cerebral palsy and delayed walking and a threefold increase for hypertonia and hyperreflexia/clonus. The results suggest that ventriculomegaly, observed even as early as the first week of life, might be a significant antecedent of later motor abnormalities among the survivors of periventricular-intraventricular hemorrhage.

Key Words: periventricular-intraventricular hemorrhage • phenobarbital • motor abnormalities

Submitted on March 3, 1989
Accepted on July 7, 1989




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