Ultrasonographic Manifestations Of Germinal Matrix Haemorrhage And Periventricular Leukomalacia In Preterm Neonates At Teaching Hospital Peradeniya
P. P. Chandrasekera, P. B. Hewavithana, S. Rosairo, M. H. M. N. Herath, D. M. R. D. Mirihella
Index Terms: Preterm neonates, Hypoxic Ischaemic Brain damage (HIBD), cranial ultrasonography, Germinal Matrix Haemorrhage (GMH), Periventricular Leukomalacia (PVL), hydrocephalus, cerebral palsy
Abstract: Germinal Matrix Haemorrhage (GMH) and Periventricular Leukomalacia (PVL) are two common types of brain injuries seen in preterm neonates for which cerebral hypoxia and ischaemia are major contributory factors. The objective of this study was to determine the type and grade of GMH and PVL on cranial ultrasonography to predict the neuro-developmental outcome. This is a descriptive study. Two hundred and sixty four preterm neonates between 28-34 weeks of gestation with risk factors and clinical features of brain injuries admitted to Special Care Baby Unit (SBU), Teaching Hospital Peradeniya from January 2013 to December 2013 were included in the study. Neonates with congenital anomalies, traumatic birth injuries, recurrent hypoglycaemia and bleeding disorders were excluded. Cranial ultrasound scans were done by an experienced Medical Officer, Professor of Radiology and Consultant Radiologist using a dedicated neonatal head probe 4-10 MHz of Logic e portable ultrasound scanner. Measurements of the lesions and ventricles were documented. A series of ultrasound scans were done for all the neonates, within the first three days of life, on day 7 and thereafter once a week until one month of age. Clinical history of seizures, abnormal head growth (microcephaly or hydrocephalus) and developmental milestones were assessed and neurological examination was done monthly for all babies till the age of one year. Monthly ultrasound scans were done for neonates who had GMH and PVL. Informed written consent was obtained from the parents of the neonates. The results were analyzed by using SPSS version 14. GMH was seen in 76(75%) neonates. PVL was seen only in 11(11%) neonates. A combination of GMH and PVL was detected in 10(10%) neonates. All the neonates with Grade IV GMH succumbed. Among the live neonates 2 out of 3 with Grade III GMH had gross motor developmental delay and all the neonates with Grades 2 and 3 PVL had cerebral palsy. Neonates with Grades I and II GMH and Grade 1 PVL did not manifest any neurological defects till one year of age. When considering brain injuries of preterm neonates less severe brain injuries are more likely with Grades I and II GMH and Grade 1 PVL which have a good prognosis while severe brain injuries are more likely with Grades III and IV GMH and Grades 2 and 3 PVL which have poor outcomes such as neonatal deaths, cerebral palsy or gross motor developmental delay.
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