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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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Births between 23 and 34 weeks: risk factors for neonatal white matter injury
From OB/GYN News, 4/15/04 by Sharon Worcester

NEW ORLEANS -- Culture-positive neonatal infection is associated with development of white matter injury, which is a major precursor of neurologic impairment and cerebral palsy, Dr. Cynthia Holcroft said at the annual meeting of the Society for Maternal-Fetal Medicine.

Positive neonatal urine, blood, cerebrospinal fluid, and tracheal cultures each occurred more often among 150 babies with white matter injury than among 150 controls in a retrospective study of births between 23 and 34 weeks' gestation.

White matter injury in this study was characterized by periventricular leukomalacia or ventricular dilatation; the babies studied were free of other chromosomal abnormalities and congenital anomalies, said Dr. Holcroft of Johns Hopkins University, Baltimore. Compared with controls, the babies with white matter injuries had higher percentages of positive urine cultures (13% vs. 7%), blood cultures (29% vs. 19%). CSF cultures (17% vs. 6%), and tracheal cultures (22% vs. 9%). The differences were significant for the blood, cerebrospinal, and tracheal cultures.

There was also an association between multiple gestation and white matter injury; 24% of cases were from a multiple gestation, compared with 14% of controls.

Histologic funisitis and chorioamnionitis were not associated with an increased risk of neonatal white matter injury, and there were no significant differences between cases and controls with regard to intrauterine growth restriction, cesarean delivery, preeclampsia, steroid use, preterm premature rupture of membranes, abruption, placenta previa, or incidence of metabolic acidosis, Dr. Holcroft noted.

BY SHARON WORCESTER

Tallahassee Bureau

COPYRIGHT 2004 International Medical News Group
COPYRIGHT 2004 Gale Group

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