Correlation Between Neonatal Cranial Ultrasound, MRI in Infancy and Neurodevelopmental Outcome in Infants with a Large Intraventricular Haemorrhage with or without Unilateral Parenchymal Involvement

L. S. de Vries; K. J. Rademaker; F. Groenendaal; P. Eken; I. C. van Haastert; W. P. Vandertop; R. Gooskens; L. C. Meiners

doi:10.1055/s-2007-973558

Neuropediatrics 1998; 29(4): 180-188
DOI: 10.1055/s-2007-973558

Original articles

Correlation Between Neonatal Cranial Ultrasound, MRI in Infancy and Neurodevelopmental Outcome in Infants with a Large Intraventricular Haemorrhage with or without Unilateral Parenchymal Involvement

L. S. de Vries¹ , K. J. Rademaker¹ , F. Groenendaal¹ , P. Eken¹ , I. C. van Haastert² , W. P. Vandertop³ , R. Gooskens⁴ , L. C. Meiners⁵

¹Departments of Neonatology, Wilhelmina Children's Hospital, Utrecht;
²Departments of Paediatric Physiotherapy, Wilhelmina Children's Hospital, Utrecht;
³Department of Neurosurgery, University Hospital, Utrecht;
⁴Department of Paediatric Neurology, Wilhelmina Children's Hospital, Utrecht;
⁵Department of Radiology, University Hospital Utrecht, The Netherlands

Abstract

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Abstract

During a 7 - year - period, 1625 infants of 34 weeks gestation or less were enrolled in a prospective ultrasound (US) study. One hundred and eleven (6.8 %) infants developed a large intraventricular haemorrhage (IVH) with or without unilateral parenchymal involvement (PI).

Fifty - six of these 111 infants survived (50.4 %) and in 23 (41 %) of them a magnetic resonance imaging (MRI) study was performed beyond 12 months corrected age.

There appeared to be a good agreement between neonatal ultrasound findings and MRI changes noted in infancy. Of the 10 cases with a large IVH without PI (group A), seven had a VP shunt with complete decompression of previously enlarged ventricles. Six of these seven infants had periven - tricular hyperintensity (PVHI) but none developed cerebral palsy (CP). Two of the ten cases without a VP shunt had irregular ventricular enlargement (VE) with PVHI in one. Both developed CP. Seven cases showed thinning of the corpus callosum.

Of the 13 cases with a large IVH associated with PI (group B), the site of the PI could still be recognised on MRI and the degree of communication of the porencephalic cyst (PC) with the lateral ventricles correlated well with neonatal US findings. On MRI, VE was present in only 6 cases. Wallerian degeneration was present in 9/13 infants and all but one developed a hemiplegia. In 12/13 cases there was thinning of the corpus callosum, either focal or diffuse. PVHI was present in all infants. In 6/13 PVHI was only present around the PC.

Neurodevelopmental outcome differed for both groups. CP was only present in 2/10 infants in group A, compared to 11 / 13 in group B. Global delay, in the absence of CP, was more common in infants with a large IVH than in those with associated PI.

Conclusion

Combining neonatal US with MRI in infancy enhances our understanding of the long - term effects of severe haemorrhagic brain lesions, occurring in preterm infants.

Key words

Intraventricular haemorrhage - Venous infarction - Ultrasound - MRI - Newborn

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