A critical review of cranial ultrasounds: is there a closer association between intraventricular blood, white matter abnormalities or cysts, and cerebral palsy?

In an attempt to determine cranial ultrasonographic features of preterm infants with intraventricular hemorrhage (IVH) and/or periventricular white matter abnormalities (PVWMA) that could serve as more specific predictors of cerebral palsy (CP), we reviewed the cranial sonograms of 34 infants with IVH and/or PVWMA. Fourteen of the 34 infants studied (41%) developed CP. One of five infants with grade III IVH alone developed CP. Eleven infants with PVWMA did not develop cysts and only two (18%) developed CP (p = 0.04). Of the 18 infants who went on to develop cysts, four had a small, discrete solitary cyst and 14 had large cystic areas. Three of the four with small cysts were neurologically normal, whereas only three of the 14 with large cysts were neurologically normal (p = 0.04). Preterm infants with grade III IVH in the absence of any parenchymal lesion had a more favorable neurologic outcome than those with IVH and concomitant PVWMA. Infants with PVWMA in the presence or absence of IVH had much poorer neurologic prognoses. In infants with PVWM abnormalities, both the presence and extent of cystic lesions, though not their location, are the strongest predictors of long-term neurologic outcome.