VERY LOW BIRTHWEIGHT (VLBW) INFANTS (<1000 G): INFLUENCE OF GESTATIONAL AGE (GA) AND INTRAUTERINE GROWTH RETARDATION ON THE INCIDENCE AND SEVERITY OF CEREBRAL ISCHEMIC-HAEMORRHAGIC LESIONS. A PROSPECTIVE STUDY

Abstract

Between 1986 and 1991, 148 VLBW infants were prospectively scanned by cranial ultrasound (u/s) in order to determine the incidence of cerebral ischemic-haemorrhagie lesions and their relationship with mortality and neurodevelopmental outcome. The 1st scan was performed as soon as possible after birth, then u/s were repeated at days 2, 3, 5, 7 and then twice a month until discharge. AGA (99) and SGA (49) infants had similar BW (881±102 g vs 853±127 g) but different GA (26,8±1,3 wk vs 30,1±1,9 wk, p<0,001). 17 infants (14 AGA, 3 SGA) died <48 h of life with a normal u/s, and were excluded of lliis study. U/s were consistently normal in 46/85 AGA and 37/46 SGA infants (p<0.01). Incidence of grades I and II haemonhages were similar in both groups, but that of grade III was higher in AGA (31%) than in SGA infants (6%, p<0,05), as well as that of parenchymal lesions (19% vs 4%, p<0,05). Abnormal u/s were found in 2/18 28-29 wk SGA infants and in 10/27 wk AGA infants (p=NS) and in 7/28 ≥ 30 wk SGA infants. In the AGA group, incidence of normal u/s decreased with increasing GA, but statistical significance was not found (55% at 24-25 wk, 47% at 26-27 wk and 37% at 28-29 w). In the AGA group, mortality was of 38%, 22/38 (58%) deaths being due to extensive cerebral lesions, versus 58% (p<0.01) and 2/9 (22%. p<0.05) respectively in the SGA group. 45/99 (45%) AGA infants survived with normal u/s vs 34/49 (69%.) SGA infants (p<0,001). Conclusion : Incidence and severity of cerebral ischemic-haemorrhagic lesions are higher in AGA than in SGA VLBW infants, explaining the higher mortality rate in the first group. Nevertheless, no significant difference between the 2 groups was found at 28-29 wk GA.

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