The dramatic improvement in neonatal care during the last decade did n
ot succeed in reducing the incidence of periventricular leukomalacia (
PVL), suggesting that prenatal events may be the main target for PVL p
revention. The studied cohort included 753 very preterm infants born b
etween 24 and 32 weeks of gestational age, admitted to the intensive c
are unit and surviving at least 7 days; 69 (9.2%) of these infants had
a diagnosis of cystic PVL. The highest PVL frequency was observed amo
ng the infants born at 28 weeks of gestation (16%). Inflammatory prena
tal events occurring during the last days or weeks before delivery and
PVL occurrence are strongly correlated. Indeed, the combination of in
tra-uterine infection and premature rupture of membranes is associated
with a very high risk (22%). Prolongation of pregnancy with tocolysis
for more than 24 hours also carries a significant 8% risk of PVL. In
contrast, chronic fetal distress of long duration, such as severe intr
a-uterine growth retardation and pre-eclampsia, is seldom followed by
PVL (<2% risk). Similarly, rapid unexpected deliveries entail a minima
l PVL risk (4%). Experimental and epidemiological confirmations of the
se data would have an influence on the management of both the preterm
onset of labour and the premature rupture of membranes.