OBSTETRIC ANTECEDENTS OF INTRAVENTRICULAR HEMORRHAGE AND PERIVENTRICULAR LEUKOMALACIA IN THE LOW-BIRTH-WEIGHT NEONATE

OBJECTIVE: Neonatal intraventricular hemorrhage and periventricular le ukomalacia have a strong correlation with eventual neurologic deficit. Our objective was to correlate obstetric factors with the development of these lesions. STUDY DESIGN: Seven hundred forty-five consecutive inborn neonates with birth weights from 500 to 1750 gm were divided in to three clinical groups: premature rupture of membranes, refractory p reterm labor with intact membranes, and delivery initiated by the phys ician for maternal or fetal indications. Neonatal neurosonography was performed on days 3 and 7 of life and results were described as normal or abnormal. Abnormal scans included intraventricular hemorrhage seen within 3 days and echodense or echolucent periventricular leukomalaci a seen within 7 days of life. Major abnormalities included intraventri cular hemorrhage grades 3 and 4, intraventricular hemorrhage with peri ventricular leukomalacia, and echolucent periventricular leukomalacia. Abnormal scans were correlated with groups of origin and clinical and histologic chorioamnionitis. RESULTS: Abnormal scans occurred in 33% of cases of premature rupture of membranes and in 38.9% of cases of pr eterm labor compared with 17.7% of physician-initiated cases (p < 0.00 0001). Major lesions occurred in 17.6% of cases of premature rupture o f membranes, 21.4% of cases of preterm labor, and 1.1% of physician-in itiated cases (p < 0.0000001). Clinical chorioamnionitis occurred in 1 9.7% of cases of premature rupture of membranes, 11.9% of cases of pre term labor, and 1.1% of physician-initiated cases (p < 0.001) and was associated with a significant increase in the incidence (p less than o r equal to 0.005) and severity (p less than or equal to 0.007) of thes e lesions. Histologic chorioamnionitis occurred in 59.9% of cases of p remature rupture of membranes, 43.2% of cases of preterm labor, and 8% of physician-initiated cases and did not correlate significantly with the incidence or severity of abnormal scans. These findings were inde pendent of gestational age. CONCLUSIONS: The incidence and severity of intraventricular hemorrhage and periventricular leukomalacia were sig nificantly increased in premature rupture of membranes and preterm lab or compared with the physician-initiated cases. Clinical chorioamnioni tis increased the incidence and severity of these lesions.