Punctate white matter lesions of preterm infants: Risk factor analysis

Alessandro Parodi; Mariya Malova; Valentina Cardiello; Sarah Raffa; Martina Re; Maria Grazia Calevo; Mariasavina Severino; Domenico Tortora; Giovanni Morana; Andrea Rossi; Luca Antonio Ramenghi

doi:10.1016/j.ejpn.2019.06.003

Punctate white matter lesions of preterm infants: Risk factor analysis

Alessandro Parodi, Mariya Malova, Valentina Cardiello, Sarah Raffa, Martina Re, Maria Grazia Calevo, Mariasavina Severino, Domenico Tortora, Giovanni Morana, Andrea Rossi, Luca Antonio Ramenghi

Research output: Contribution to journal › Article › peer-review

Abstract

AIM: Punctate white matter lesions (PWML) are frequently detected in preterm infants undergoing brain MRI at term equivalent age (TEA). The aims of this study were to assess prevalence of PWML and to identify risk factors for PWML in VLBW infants.

METHODS: Brain MRI scans obtained at TEA and clinical charts of a consecutive sample of very low birth weight (VLBW) infants admitted to Gaslini Children's Hospital NICU between 2012 and 2016 were retrospectively analyzed. MRI protocol included Susceptibility Weighted Imaging (SWI) sequence in order to identify hemosiderin depositions as a result of previous microbleeds. PWML were classified according to their number (≤6 lesions and >6 lesions) and signal characteristics (SWI+ lesions and SWI- lesions). Univariate and multivariable analysis were performed in order to identify risk factors for PWML (as a whole) and for each subgroup of PWML.

RESULTS: 321 VLBW infants were included. PWML were identified in 61 subjects (19%), 26 of whom (8% of the study population) had more than 6 lesions. Risk factors for PWML (as a whole) were higher birth weight (OR = 1.001; p = 0.04) and absent or incomplete antenatal steroid course (OR = 2.13; p = 0.02). Risk factors for >6 PWML were need for intubation (OR = 11.9; p = 0.003) and higher Apgar score at 5 min (OR = 1.8; p = 0.02). Presence of GMH-IVH was the only identified risk factor for SWI + lesions.

CONCLUSIONS: Our results confirm the high prevalence of PWML among VLBW infants. Differentiation between SWI+ and SWI- lesions is crucial as they have different risk factors and may likely represent two different entities.

Original language	English
Pages (from-to)	733-739
Number of pages	7
Journal	European Journal of Paediatric Neurology
Volume	23
Issue number	5
DOIs	https://doi.org/10.1016/j.ejpn.2019.06.003
Publication status	Published - Sep 2019

Keywords

Brain/diagnostic imaging
Factor Analysis, Statistical
Female
Humans
Infant
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases/diagnostic imaging
Infant, Very Low Birth Weight
Magnetic Resonance Imaging/methods
Male
Pregnancy
Retrospective Studies
Risk Factors
White Matter/diagnostic imaging

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Punctate white matter lesions of preterm infants : Risk factor analysis. / Parodi, Alessandro; Malova, Mariya; Cardiello, Valentina; Raffa, Sarah; Re, Martina; Calevo, Maria Grazia ; Severino, Mariasavina ; Tortora, Domenico ; Morana, Giovanni; Rossi, Andrea; Ramenghi, Luca Antonio.

In: European Journal of Paediatric Neurology, Vol. 23, No. 5, 09.2019, p. 733-739.

Research output: Contribution to journal › Article › peer-review

Parodi, Alessandro ; Malova, Mariya ; Cardiello, Valentina ; Raffa, Sarah ; Re, Martina ; Calevo, Maria Grazia ; Severino, Mariasavina ; Tortora, Domenico ; Morana, Giovanni ; Rossi, Andrea ; Ramenghi, Luca Antonio. / Punctate white matter lesions of preterm infants : Risk factor analysis. In: European Journal of Paediatric Neurology. 2019 ; Vol. 23, No. 5. pp. 733-739.

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title = "Punctate white matter lesions of preterm infants: Risk factor analysis",

abstract = "AIM: Punctate white matter lesions (PWML) are frequently detected in preterm infants undergoing brain MRI at term equivalent age (TEA). The aims of this study were to assess prevalence of PWML and to identify risk factors for PWML in VLBW infants.METHODS: Brain MRI scans obtained at TEA and clinical charts of a consecutive sample of very low birth weight (VLBW) infants admitted to Gaslini Children's Hospital NICU between 2012 and 2016 were retrospectively analyzed. MRI protocol included Susceptibility Weighted Imaging (SWI) sequence in order to identify hemosiderin depositions as a result of previous microbleeds. PWML were classified according to their number (≤6 lesions and >6 lesions) and signal characteristics (SWI+ lesions and SWI- lesions). Univariate and multivariable analysis were performed in order to identify risk factors for PWML (as a whole) and for each subgroup of PWML.RESULTS: 321 VLBW infants were included. PWML were identified in 61 subjects (19%), 26 of whom (8% of the study population) had more than 6 lesions. Risk factors for PWML (as a whole) were higher birth weight (OR = 1.001; p = 0.04) and absent or incomplete antenatal steroid course (OR = 2.13; p = 0.02). Risk factors for >6 PWML were need for intubation (OR = 11.9; p = 0.003) and higher Apgar score at 5 min (OR = 1.8; p = 0.02). Presence of GMH-IVH was the only identified risk factor for SWI + lesions.CONCLUSIONS: Our results confirm the high prevalence of PWML among VLBW infants. Differentiation between SWI+ and SWI- lesions is crucial as they have different risk factors and may likely represent two different entities.",

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author = "Alessandro Parodi and Mariya Malova and Valentina Cardiello and Sarah Raffa and Martina Re and Calevo, {Maria Grazia} and Mariasavina Severino and Domenico Tortora and Giovanni Morana and Andrea Rossi and Ramenghi, {Luca Antonio}",

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doi = "10.1016/j.ejpn.2019.06.003",

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T1 - Punctate white matter lesions of preterm infants

T2 - Risk factor analysis

AU - Parodi, Alessandro

AU - Malova, Mariya

AU - Cardiello, Valentina

AU - Raffa, Sarah

AU - Re, Martina

AU - Calevo, Maria Grazia

AU - Severino, Mariasavina

AU - Tortora, Domenico

AU - Morana, Giovanni

AU - Rossi, Andrea

AU - Ramenghi, Luca Antonio

PY - 2019/9

Y1 - 2019/9

N2 - AIM: Punctate white matter lesions (PWML) are frequently detected in preterm infants undergoing brain MRI at term equivalent age (TEA). The aims of this study were to assess prevalence of PWML and to identify risk factors for PWML in VLBW infants.METHODS: Brain MRI scans obtained at TEA and clinical charts of a consecutive sample of very low birth weight (VLBW) infants admitted to Gaslini Children's Hospital NICU between 2012 and 2016 were retrospectively analyzed. MRI protocol included Susceptibility Weighted Imaging (SWI) sequence in order to identify hemosiderin depositions as a result of previous microbleeds. PWML were classified according to their number (≤6 lesions and >6 lesions) and signal characteristics (SWI+ lesions and SWI- lesions). Univariate and multivariable analysis were performed in order to identify risk factors for PWML (as a whole) and for each subgroup of PWML.RESULTS: 321 VLBW infants were included. PWML were identified in 61 subjects (19%), 26 of whom (8% of the study population) had more than 6 lesions. Risk factors for PWML (as a whole) were higher birth weight (OR = 1.001; p = 0.04) and absent or incomplete antenatal steroid course (OR = 2.13; p = 0.02). Risk factors for >6 PWML were need for intubation (OR = 11.9; p = 0.003) and higher Apgar score at 5 min (OR = 1.8; p = 0.02). Presence of GMH-IVH was the only identified risk factor for SWI + lesions.CONCLUSIONS: Our results confirm the high prevalence of PWML among VLBW infants. Differentiation between SWI+ and SWI- lesions is crucial as they have different risk factors and may likely represent two different entities.

AB - AIM: Punctate white matter lesions (PWML) are frequently detected in preterm infants undergoing brain MRI at term equivalent age (TEA). The aims of this study were to assess prevalence of PWML and to identify risk factors for PWML in VLBW infants.METHODS: Brain MRI scans obtained at TEA and clinical charts of a consecutive sample of very low birth weight (VLBW) infants admitted to Gaslini Children's Hospital NICU between 2012 and 2016 were retrospectively analyzed. MRI protocol included Susceptibility Weighted Imaging (SWI) sequence in order to identify hemosiderin depositions as a result of previous microbleeds. PWML were classified according to their number (≤6 lesions and >6 lesions) and signal characteristics (SWI+ lesions and SWI- lesions). Univariate and multivariable analysis were performed in order to identify risk factors for PWML (as a whole) and for each subgroup of PWML.RESULTS: 321 VLBW infants were included. PWML were identified in 61 subjects (19%), 26 of whom (8% of the study population) had more than 6 lesions. Risk factors for PWML (as a whole) were higher birth weight (OR = 1.001; p = 0.04) and absent or incomplete antenatal steroid course (OR = 2.13; p = 0.02). Risk factors for >6 PWML were need for intubation (OR = 11.9; p = 0.003) and higher Apgar score at 5 min (OR = 1.8; p = 0.02). Presence of GMH-IVH was the only identified risk factor for SWI + lesions.CONCLUSIONS: Our results confirm the high prevalence of PWML among VLBW infants. Differentiation between SWI+ and SWI- lesions is crucial as they have different risk factors and may likely represent two different entities.

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KW - Factor Analysis, Statistical

KW - Female

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Infant, Premature

KW - Infant, Premature, Diseases/diagnostic imaging

KW - Infant, Very Low Birth Weight

KW - Magnetic Resonance Imaging/methods

KW - Male

KW - Pregnancy

KW - Retrospective Studies

KW - Risk Factors

KW - White Matter/diagnostic imaging

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DO - 10.1016/j.ejpn.2019.06.003

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JO - European Journal of Paediatric Neurology

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