PROVINCE-BASED STUDY OF NEUROLOGIC DISABILITY OF CHILDREN WEIGHING 500 THROUGH 1249 GRAMS AT BIRTH IN RELATION TO NEONATAL CEREBRAL ULTRASOUND FINDINGS

Background. Adverse neurodevelopmental outcome in premature infants is more common in the presence of certain ultrasonographically detectabl e intracranial lesions. Present nomenclature and classifications of pa renchymal changes in preterm infants of varying gestations have led to some confusion. Descriptive definitions may be clinically useful. Reg ionalized perinatal and neonatal fare enables population-based studies of these lesions and subsequent outcomes. Methods. Two- to 3-year out comes of neonates weighing 500 through 1249 g born in Alberta to Alber ta residents during 1987 through 1990 were reviewed in relation to neo natal cerebral ultrasound lesions. Odds ratios and confidence limits f or disability were calculated. Results. Of 960 live births in this wei ght group, 669 (70%) survived to 1 year adjusted age; 646 (96.6%) were assessed at follow-up, and 80 (12.4%) of these were disabled: cerebra l palsy, 8.7%; vision loss, 2.9%; hearing loss, 1.3%; epilepsy, 0.6%; mental retardation, 4.8%; more than one disability per child, 3.6%; an d projected dependent disability, 1.4%. Lesions considered to be predi ctive of disability on ultrasound (excluding germinal layer hemorrhage ) were found in 79 (11.8%), parenchymal lesions in 63 (9.4%) of 1-year survivors: intraventricular hemorrhage (IVH) (n = 59), persistent or transient cerebral ventriculomegaly (n = 50), persistent or transient intraparenchymal periventricular echodensity (n = 29), and cystic peri ventricular leukomalacia (n = 7). All lesions except isolated IVH were associated with adverse outcome; 37% of disabled children, 61% of mul tiply disabled children, and all children projected to become dependen tly disabled had parenchymal lesions with or without IVH. Triple lesio ns of IVH, cerebral ventriculomegaly, and intraparenchymal periventric ular echodensity gave an odds ratio for disability of 50. Transient le sions had significant risk. Conclusions. This province-based study pro vides a descriptive scheme of serial neonatal cerebral ultrasound lesi ons and outcome considered useful for clinicians caring for newborns o f lowest gestational ages. The overall incidence of parenchymal lesion s was lower than frequently reported. Combinations of lesions were lin ked to increased incidence, complexity, and severity of childhood disa bility.