PEDIATRICS Vol. 91 No. 2 February 1993, pp. 474-480
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Perlman, J. M.
Right arrow Articles by Risser, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Perlman, J. M.
Right arrow Articles by Risser, R.

Relationship Between Periventricular Intraparenchymal Echodensities and Germinal Matrix-Intraventricular Hemorrhage in the Very Low Birth Weight Neonate

Jeffrey M. Perlman MB1, Nancy Rollins MD2, Dennis Burns MD3, and Rick Risser MS4

1 From the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
2 From the Department Radiology, University of Texas Southwestern Medical Center, Dallas
3 From the Department Neuropathology, University of Texas Southwestern Medical Center, Dallas
4 From the Department Academic Computing, University of Texas Southwestern Medical Center, Dallas

The pathogenesis of the periventricular intraparenchymal echodense lesion (IPE) observed in association with germinal matrix-intraventricular hemorrhage (GM-IVH) in premature neonates is unclear. The objectives of this study were to determine (1) the temporal characteristics of GM-IVH and IPE, (2) the basic characteristics of the IPE, and (3) the relationship of clinical events, including surfactant administration, to IPE. One hundred twenty-four neonates of less than 1250 g birth weight were prospectively evaluated. IPE was defined as an echodensity greater than 1 cm in diameter by cranial sonography. Fifteen (12%) neonates developed IPE in association with GM-IVH (group 1); 33 neonates developed GM-IVH only (group 2) and 76 neonates without GM-IVH served as comparison group (group 3). IPE was essentially an asymmetrical lesion; both sides of cerebrum were equally affected. The lesion was diffuse in 9 neonates and focal in 5. IPE occurred both early, at 36 hours or before (n = 8), and later, ie, between 48 and 96 hours (n = 6). In one neonate IPE was diagnosed at autopsy. GM-IVH and IPE were noted simultaneously in neonate with the earlier onset IPE (diagnosed within 36 hours); GM-IVH preceded the IPE by 6 to 48 hours when the lesion was of a later onset. Surfactant was administered to 13 (87%) group 1, 24 (73%) group 2, and 35 (46%) group 3 neonates. Pulmonary hemorrhage developed in 9 (60%) of group 1, 3 (9%) group 2, and no group 3 neonates. Symptomatic patent ductus arteriosus occurred in 12 (75%) group 1, 15 (45%) group 2, and 15 (20%) group 3 neonates. The onset of symptoms associated with patent ductus arteriosus was earlier in group 1 vs group 2 or group 3 neonates, ie, 70 vs 172 hours. Nine (60%) group 1 neonates, 6 (18%) group 2, and 5 (7%) group 3 neonates died. The cranial sonogram was markedly abnormal in all 6 group 1 survivors. Stepwise polytomous logistic regression indicated that birth weight, gestational age, and emergent cesarean section were the best predictors of GM-IVH + IPE. These data indicate that (1) the large IPE observed with GM-IVH remains a major problem of the very low birth weight neonate, despite surfactant administration; (2) complications during labor that lead to emergent cesarean section appear to increase the risk for IPE; and (3) IPE was frequently associated with PH, but the precise mechanism(s) that link these two lesions are unclear. Attempts at prevention of IPE need to consider both perinatal and postnatal provocative factors.

Key Words: periventricular echodensities • intraventricular hemorrhage • low birth weight • pulmonary hemorrhage

Submitted on July 17, 1992
Accepted on October 20, 1992




This article has been cited by other articles:


Home page
 PediatricsHome page
E. Roze, J. M. Kerstjens, C. G.B. Maathuis, H. J. ter Horst, and A. F. Bos
Risk Factors for Adverse Outcome in Preterm Infants With Periventricular Hemorrhagic Infarction
Pediatrics, July 1, 2008; 122(1): e46 - e52.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
K. Alfaleh, J. A. Smyth, R. S. Roberts, A. Solimano, E. V. Asztalos, B. Schmidt, and for the Trial of Indomethacin Prophylaxis in Prete
Prevention and 18-Month Outcomes of Serious Pulmonary Hemorrhage in Extremely Low Birth Weight Infants: Results From the Trial of Indomethacin Prophylaxis in Preterms
Pediatrics, February 1, 2008; 121(2): e233 - e238.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
H. Bassan, C. Limperopoulos, K. Visconti, D. L. Mayer, H. A. Feldman, L. Avery, C. B. Benson, J. Stewart, S. A. Ringer, J. S. Soul, et al.
Neurodevelopmental Outcome in Survivors of Periventricular Hemorrhagic Infarction
Pediatrics, October 1, 2007; 120(4): 785 - 792.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
H. Bassan, C. B. Benson, C. Limperopoulos, H. A. Feldman, S. A. Ringer, E. Veracruz, J. E. Stewart, J. S. Soul, D. N. DiSalvo, J. J. Volpe, et al.
Ultrasonographic features and severity scoring of periventricular hemorrhagic infarction in relation to risk factors and outcome.
Pediatrics, June 1, 2006; 117(6): 2111 - 2118.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
J. M. Perlman
Morphine, Hypotension, and Intraventricular Hemorrhage in the Ventilated Premature Infant
Pediatrics, May 1, 2005; 115(5): 1416 - 1418.
[Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
S J Counsell, M A Rutherford, F M Cowan, and A D Edwards
Magnetic resonance imaging of preterm brain injury
Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2003; 88(4): F269 - F274.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
B. R. Vohr, W. C. Allan, M. Westerveld, K. C. Schneider, K. H. Katz, R. W. Makuch, and L. R. Ment
School-Age Outcomes of Very Low Birth Weight Infants in the Indomethacin Intraventricular Hemorrhage Prevention Trial
Pediatrics, April 1, 2003; 111(4): e340 - 346.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
J. M. Perlman and N. Rollins
Surveillance Protocol for the Detection of Intracranial Abnormalities in Premature Neonates
Arch Pediatr Adolesc Med, August 1, 2000; 154(8): 822 - 826.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
L. R. Ment, B. Vohr, W. Allan, M. Westerveld, S. S. Sparrow, K. C. Schneider, K. H. Katz, C. C. Duncan, and R. W. Makuch
Outcome of Children in the Indomethacin Intraventricular Hemorrhage Prevention Trial
Pediatrics, March 1, 2000; 105(3): 485 - 491.
[Abstract] [Full Text]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
P. Govaert, K Smets, E Matthys, and A Oostra
Neonatal focal temporal lobe or atrial wall haemorrhagic infarction
Arch. Dis. Child. Fetal Neonatal Ed., November 1, 1999; 81(3): 211F - 216.
[Abstract] [Full Text]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
P. B Pandit, K. O'Brien, E. Asztalos, E. Colucci, and M. S Dunn
Outcome following pulmonary haemorrhage in very low birthweight neonates treated with surfactant
Arch. Dis. Child. Fetal Neonatal Ed., July 1, 1999; 81(1): 40F - 44.
[Abstract] [Full Text]

Home page
 PediatricsHome page
A. Leviton, N. Paneth, M. Susser, M. L. Reuss, E. N. Allred, K. Kuban, U. Sanocka, T. Hegyi, M. Hiatt, F. Shahrivar, et al.
Maternal Receipt of Magnesium Sulfate Does Not Seem to Reduce the Risk of Neonatal White Matter Damage
Pediatrics, April 1, 1997; 99(4): e2 - e2.
[Abstract] [Full Text] [PDF]