Unexpected versus anticipated cystic periventricular leukomalacia.

The objective of this study is to contrast the clinical profile of premature infants who develop cystic periventricular leukomalacia (cPVL) following a severe hemodynamic event (anticipated) with infants whose cPVL is not preceded by such an event (unexpected). The study design is a Retrospective Cohort. The study setting is a Neonatal Intensive Care Unit. Infants born at a gestational age of 23-32 weeks received serial cranial ultrasounds to screen for cPVL. Infants were divided into two groups based upon whether or not they had experienced a hemodynamic event of sufficient severity to potentially cause cPVL. Details of the clinical profile of these two groups were compared. Cystic PVL occurred in 27 infants (2.1%). In 15 infants (56%) cPVL was antipicated as there was at least one severe preceding hemodynamic event. Twelve infants (44%) had not experienced such an event and the discovery of cPVL on routine cranial ultrasound was unexpected. These infants were more likely to have been born to mothers who had received tocolytics (67 versus 13%, p = 0.004), prenatal steroids (67 vs. 27%, p = 0.038), and intrapartum antibiotics (92 vs. 20%, p < 0.001) and were more likely to have been delivered more than 6 hours after arrival to the hospital (83 vs. 40%; p = 0.038) than infants whose cPVL was anticipated. The diagnosis of clinical chorioamnionitis was also more common in the group of infants whose cPVL was unexpected (50 vs. 13%, p = 0.038). Almost half (44%) of our cases of cPVL occurred unexpectedly in infants who did not appear to have an obvious cause, as they had not experienced a severe hemodynamic event. These infants were more commonly delivered to mothers who had been hospitalized long enough to have received a variety of prenatal therapies and more often had a diagnosis of chorioamnionitis.