PERIVENTRICULAR LEUKOMALACIA - RISK-FACTORS REVISITED

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.