51 INCIDENCE OF ISCHAEMIC-HAEMORRHAGIC BRAIN LESIONS OTHER THAN INTRAVENTRICULAR HAEMORRHAGES IN PREMATURE INFANTS BORN BEFORE 29 WEEKS' GESTATION. A PROSPECTIVE ULTRASOUND STUDY

Abstract

Our aim was to determine the incidence of ischaemic-haemorrhagic brain lesions other than intraventricular haemorrhages (IVH) in premature infants born at a gestational age (GA) < 29 weeks. Between 1986 and 1991, 102 infants < 29 wk GA (ranges : 24-28 wk) were prospectively scanned by cranial ultrasound (u/s). 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. A 7, 5 MHz transducer was used. 16 (16%) infants died < 48 h of life with a normal u/s and were excluded of this study. 18/86 (21%) infants developped ischaemic-haemorrhagic lesions into either the brain parenchyma, the cerebellum and the posterior cerebral fossa. 17 infants died in the neonatal period, and permission for autopsy was obtained in 15 of them. Parenchymal bleeding associated to large IVH and thought to be haemorrhagic of origin was seen in 13 infants (11 autopsies were done and confirmed the u/s appearance). Cerebellum was involved in 5 cases : 1 isolated lesion, 4 lesions associated with extensive IVH and parenchymal bleeding (1 of these being seen only at autopsy). Posterior fossa was involved in 3 cases, all having other types of bleeding (1 only seen at autopsy). The only surviving; infant had a bilateral cystic parietal and occipital leukomalacia diagnosed at 7 weeks of age, and developped cerebral palsy at follow-up.

Conclusion : u/s can detect accurately ischaemic-haemorrhagic lesions, associated to IVH or isolated. In this population of very premature infants, ischaemic leukomalacia is not frequent (6%), and cerebellar lesions are not rare (28%).

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