OBSTETRIC RISK-FACTORS FOR PERIVENTRICULAR LEUKOMALACIA AMONG PRETERMINFANTS

Objective To evaluate the obstetric antecedents of cystic periventricu lar leukomalacia and transient echodense periventricular lesions among preterm infants. Design A cohort study of preterm singleton infants b orn between 25 and 33 weeks gestation. Setting Pavia, Italy. Populatio n Three hundred and forty-nine infants admitted to a Division of Neona tal Intensive Care who were screened for periventricular leukomalacia. Method The obstetric factors in infants with either cystic periventri cular leukomalacia or transient echodense periventricular lesions were compared to those in infants with negative cranial ultrasonographic f indings. Stepwise multiple logistic regression analysis was used to ev aluate the association between risk factors and outcomes adjusting for confounders. Results The prevalence of cystic periventricular leukoma lacia and transient echodense lesions was 5.7% (20/349) and 14% (49/34 9), respectively. The main risk factors for cystic leukomalacia were f irst trimester haemorrhage (OR 4.49; 95% CI 1.63-12.39), maternal urin ary tract infection on admission (OR 5.71; 95% CI 1.91-17.07), and neo natal acidosis (pH < 7.2) at birth (OR 5.97; 95% CI 1.93-18.52). Mecon ium-stained amniotic fluid (OR 3.95; 95% CI 1.42-10.98) and long term (> 72 hours) ritodrine tocolysis (OR 2.54; 95% CI 1.28-5.05) were asso ciated with an increased risk of echodense lesions. The likelihood of overall leukomalacia (cystic plus echodense periventricular lesions) w as increased among cases with meconium-stained amniotic fluid (OR 4.06 ; 95% CI 1.65-10.0), long-term ritodrine tocolysis (OR 2.56; 95% CI 1. 38-4.72), maternal infection (OR 1.73; 95% CI 1.0-3.0), and acidosis a t birth (OR 1.98; 95% CI 1.0-3.98). Conclusions This study confirms th at maternal infection, acidosis at birth, and meconium-stained amnioti c fluid increase the risk of periventricular leukomalacia in preterm i nfants. Long-term ritodrine use seems to increase the risk for transie nt echodense lesions.