BACKGROUND: The development of periventricular @entity62 (PWMI) in the preterm neonate is the most common insult portending @entity16 and is linked with the later development of @entity306 . The pathogenesis of PWMI targets premyelinating oligodendrocytes of the periventricular region secondary to free radicals, cytokine @entity137 , and excitatory neurotransmitters. The primitive nature of the vasculature in the developing fetal cortex lends to its predilection to PWMI and @entity2806 with less arterial anastomoses at arterial border zones and failure to compensate for global @entity551 , termed the "pressure-passive" circulation. OBJECTIVE: Our objective is to determine the relative risk (RR) of fetal @entity520 and @entity281 in the development of PWMI in very low birthweight (VLBW) (<1500 g) neonates. STUDY DESIGN: This is a cohort study of all VLBW neonates admitted to our neonatal intensive care unit from April 2009 through December 2014, comparing those who developed PWMI on neonatal head ultrasound at 6 weeks of life to those who did not. Neonates with chromosomal or major @entity154 were excluded. Generalized linear modeling, adjusting for variables significantly different on bivariate analysis, was conducted. RESULTS: During this 5-year and 8-month period there were 374 VLBW neonates admitted; 35 (9.4%) had PWMI. VLBW neonates without PWMI were significantly more likely to have intrauterine growth restriction (2.9% PWMI, 21.5% no PWMI; P  = .006), while those neonates with PWMI had a significantly lower gestational age (26.3    2.2 vs 28.0    2.5 weeks; P < .001) and birthweight (868    237 vs 993    276 g; P  = .009). There was no significant difference in umbilical arterial pH (7.25    0.15 vs 7.27    0.09; P  = .34), base deficit (4.6    6.0 vs 3.4    3.3 mmol/L; P  = .11), or pH <7.0 or base deficit >12 mmol/L at birth (10.7% vs 3.2%; P  = .09). On bivariate analysis neonates with PWMI had a significant increase in positive cerebrospinal fluid (CSF) cultures (22.9% vs 1.5%; P < .001). The initial lumbar puncture was performed at a similar day of life, and neonates with PWMI had significantly elevated CSF white blood cell counts (5%, 50%, and 95%; 16, 175, and 709/mm(3); 1, 3, and 27/mm(3); P  = .008). Generalized linear modeling, adjusted for gestational age and the presence of intrauterine growth restriction, showed that fetal @entity520 had RR 2.59 (95% confidence interval, 1.14-5.92; P  = .02) and neonatal CSF infection had RR 4.94 (95% confidence interval, 2.4-10.3; P < .001) for association with PWMI. CONCLUSION: The RR of neonatal CSF infection being associated with PWMI was 2-fold greater than @entity520 at the time of birth. Decreasing the incidence of @entity281 would have a greater impact on preventing PWMI, a precursor of @entity306 .

Risk factors for periventricular XXXX in very low birthweight neonates.

@entity154 :: ('MESH:D000013', 'Disease') :: ['congenital abnormalities'] @entity137 :: ('MESH:D064420', 'Disease') :: ['toxicity'] @entity2806 :: ('MESH:D002545', 'Disease') :: ['cerebral ischemia'] @entity16 :: ('MESH:D009422', 'Disease') :: ['neurologic impairment'] @entity520 :: ('MESH:D000138', 'Disease') :: ['metabolic acidosis'] @entity281 :: ('MESH:D007239', 'Disease') :: ['CSF infections', 'perinatal infection'] @entity62 :: ('MESH:D056784', 'Disease') :: ['white matter injury'] @entity551 :: ('MESH:D007022', 'Disease') :: ['hypotension'] @entity306 :: ('MESH:D002547', 'Disease') :: ['cerebral palsy']
@entity62 :: (MESH:D056784,Disease) :: ['white matter injury']
