IMPACT OF PREMATURITY AND INTRAUTERINE GROWTH-RETARDATION ON NEONATALHEMORRHAGIC AND ISCHEMIC BRAIN-DAMAGE

Low birth weight and intrauterine growth retardation are well-recogniz ed risk factors for increased mortality, morbidity and poor neurologic outcome. Risk assessment is different considering true preterm (appro priate-for-gestational-age, AGA) or growth-retarded (small-for-gestati onal-age, SGA) infants. Therefore, we carried out a study on the incid ence of hemorrhagic (peri-intraventricular hemorrhage, PIVH) and ische mic (periventricular leukomalacia) brain lesions in two groups of AGA and SGA very-low-birth-weight (VLBW) infants. In the study period (198 7-1990), 111 VLBW babies (< 1,500 g body weight) were serially studied at days 1, 3 and 7 and weekly until discharge by cerebral ultrasonogr aphy (ATL, MK 4, 7.5 MHz). 57 were VLBW-AGA babies (mean gestational a ge 2 8 weeks, mean body weight 1,106 g). 5 4 were VLBW-SGA babies (mea n gestational age 31 weeks, mean body weight 990 g). PIVH was graded a ccording to the system of Papile et al. Periventricular leukomalacia w as defined as an echodensity (> 3 mm) adjacent to the lateral border o f the ventricular body. We noted a higher incidence of PIVH in the AGA group (36.8%) than in SGA babies (18.5 %; p < 0.01, Fisher test). The AGA subgroup < 1,000 g body weight had 72.2% PIVH compared to AGA bab ies > 1,000 g (20.5 %; p < 0.01). The same relationship was observed i n SGA babies (34.8% in < 1,000 g and 6.4% in > 1,000 g babies). Ischem ic brain lesions (periventricular leukomalacia) were equally distribut ed between AGA and SGA babies (10.5 vs. 3.7 %, p > 0.5) independently of body weight category. We conclude that VLBW infants are a heterogen eous group of babies with different distribution of hemorrhagic and is chemic brain lesions, extremely low birth weight being a risk factor f or PIVH.