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Leukomalacia

Periventricular leukomalacia (PVL) is characterized by the death of the white matter of the brain due to softening of the brain tissue. It can affect fetuses or newborns; premature babies are at the greatest risk of the disorder. PVL is caused by a lack of oxygen or blood flow to the periventricular area of the brain, which results in the death or loss of brain tissue. The periventricular area (the area around the spaces in the brain called ventricles) contains nerve fibers that carry messages from the brain to the body's muscles. more...

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Although babies with PVL generally have no outward signs or symptoms of the disorder, they are at risk for motor disorders, delayed mental development, coordination problems, and vision and hearing impairments. PVL may be accompanied by a hemorrhage or bleeding in the periventricular-intraventricular area (the area around and inside the ventricles), and can lead to cerebral palsy. The disorder is diagnosed by ultrasound of the head.

Treatment

There is no specific treatment for PVL. Treatment is symptomatic and supportive. Children with PVL should receive regular medical screenings to determine appropriate interventions.

Prognosis

The prognosis for individuals with PVL depends upon the severity of the brain damage. Some children exhibit fairly mild symptoms, while others have significant deficits and disabilities.

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Nonreassuring fetal heart rate: C-sections, poor perinatal outcomes in IUGR linked
From OB/GYN News, 8/1/04 by Doug Brunk

PHOENIX -- Neonates with intrauterine growth restriction who are delivered by cesarean section for nonreassuring fetal heart rate patterns are at increased risk for adverse perinatal outcomes, Dr. Kara Coassolo reported in a poster session at the annual meeting of the American Institute of Ultrasound in Medicine.

"We may be able to tell moms that babies who are delivered for that reason are at an increased risk for complications later. The need for cesarean delivery [in cases of nonreassuring fetal heart rate patterns] may be a marker for adverse perinatal outcomes," said Dr. Coassolo of the department of obstetrics and gynecology at the University of Pennsylvania, Philadelphia.

Dr. Coassolo and her associates conducted a retrospective cohort study of 865 cases of intrauterine growth restriction (IUGR) in the department over a 5-year period. IUGR was defined as a birth weight below the 10th percentile for gestational age.

Of the 865 infants, 128 (15%) were delivered for nonreassuring fetal heart rate patterns. Investigators compared the clinical outcomes of this group with a control group, which consisted of 737 IUGR fetuses delivered vaginally or by cesarean section for another indication.

Univariate analysis revealed that compared with controls, cesarean section for nonreassuring fetal heart rate patterns was associated with a significantly higher risk for neonatal ICU admission (72% vs. 34%), respiratory distress syndrome (22% vs. 8%), and clinically significant intraventricular hemorrhage (7% vs. 3%).

Neonates delivered by cesarean section were almost two times as likely to have at least one adverse perinatal outcome, compared with controls (29% vs. 15%). Adverse perinatal outcome was defined as having at least one of the following: respiratory distress syndrome, grades 3 and 4 intraventricular hemorrhage, necrotizing enterocolitis, and periventricular leukomalacia, she said at the meeting.

When Dr. Coassolo and her associates adjusted for maternal age, black race, gestational age at delivery, and the incidence of chronic hypertension, those neonates who were delivered by cesarean section for nonreassuring fetal heart rate patterns were 3.41 times more likely than controls to be delivered to the neonatal ICU and 2.21 times more likely to have respiratory distress syndrome.

One study limitation is the fact that the investigators had incomplete information about the mothers' use of prenatal steroids, she said.

BY DOUG BRUNK

San Diego Bureau

COPYRIGHT 2004 International Medical News Group
COPYRIGHT 2004 Gale Group

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