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Periventricular leukomalacia (PVL) grades determined on the basis of magnetic resonance imaging findings (T2 fluid attenuated inversion recovery imaging sequences in the transverse plane): (A) mild-grade PVL; (B) moderate-grade PVL; and (C) severe-grade PVL. 

Periventricular leukomalacia (PVL) grades determined on the basis of magnetic resonance imaging findings (T2 fluid attenuated inversion recovery imaging sequences in the transverse plane): (A) mild-grade PVL; (B) moderate-grade PVL; and (C) severe-grade PVL. 

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This study investigates the developmental outcomes of preterm children according to severity of periventricular leukomalacia. One hundred preterm children with periventricular leukomalacia evident on brain magnetic resonance imaging and who had undergone neuropsychologic evaluation were selected. Intellectual disability was noted in 27.8% of the ch...

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... Given that preterm infants achieve language and cognitive milestones as they age, the effect of cPVL on cognitive impairment is likely to increase with age. This possibility is supported by previous studies showing associations between cPVL and learning disabilities in preschool-aged children [31][32][33]. We assume that contrasting results between motor and cognitive function in highgrade IVH group originated from the limitation of evaluating whole cognitive functions in 18-24 months of CA. ...
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Cystic periventricular leukomalacia (cPVL) is a major brain injury involving periventricular white matter that leads to neurodevelopmental impairment in very-low-birth weight (VLBW) infants. We investigated the neurodevelopmental outcomes (motor, cognition, visual, and hearing) of 5734 VLBW infants born between 2013 and 2019 and enrolled in the Korean Neonatal Network. Cranial ultrasound results were stratified by the presence of cPVL and severity of intraventricular hemorrhage (IVH) (no, low-grade [I/II], high-grade [III]). Neurodevelopmental impairment was evaluated using cerebral palsy for motor and Bayley Scales of Infant Development for cognition. cPVL was associated with motor, cognitive, and visual impairments in those without IVH and with low-grade IVH in pairwise comparisons (Cochran–Mantel–Haenszel p < 0.001). Conversely, cPVL was non-significantly correlated with cognitive impairment in high-grade IVH. In regression models adjusted for neonatal variables, isolated cPVL was strongly associated with motor (22.04; 11.39–42.63) and cognitive (3.10; 1.54–6.22) impairments. This study underlines the overall considerable significance of cPVL on NDI with divergent impacts depending on the severity of IVH and developmental indices.
... Intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) are among the most common cerebral lesions in preterm infants and represent important risk factors for adverse neurodevelopmental outcomes (1)(2)(3). According to Germany's quality report in 2015, the incidence of IVH and PVL in very low birth weight preterm infants <1,500 g are 4.0 and 1.5%, respectively (4). ...
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Background We investigated the association between cerebral tissue oxygen saturation (cStO 2 ) measured by near-infrared spectroscopy (NIRS) and cerebral lesions including intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL). Methods Preterm infants <1,500 g received continuous cStO 2 monitoring, initiated at the earliest time possible and recorded until 72 h of life. Mean cStO 2 over periods of 5, 15, 30 min and 1 h were calculated. To calculate the burden of cerebral hypoxia, we defined a moving threshold based on the 10th percentile of cStO 2 of healthy study participants and calculated the area under the threshold (AUT). cStO 2 <60% for >5 min was regarded a critical event. The study was registered on clinicaltrials.gov (ID NCT01430728, URL: https://clinicaltrials.gov/ct2/show/NCT01430728?id=NCT01430728&draw=2&rank=1 ). Results Of 162 infants (gestational age: mean 27.2 weeks, standard deviation 20 days; birth weight: mean 852 g, standard deviation 312 g) recorded, 24/12 (14.8%/7.4) developed any/severe IVH/PVL. Mean cStO 2 was significantly lower in infants with IVH/PVL as well as severe IVH/PVL. In addition, we observed critical events defined by mean cStO 2 over 5 min <60% in four infants with severe IVH/PVL during NIRS monitoring. AUT showed no statistically significant difference between outcome groups. Conclusion These findings suggest that cStO 2 is lower in infants developing IVH/PVL. This may be related to lower oxygenation and/or perfusion and implies that cStO 2 could potentially serve as an indicator of imminent cerebral lesions.
... Nonspecific findings included, but were not limited to, subcortical white matter T2 hyperintensities, meningiomas without mass effect, and lobar or diffuse cortical volume loss [57,64,[68][69][70][71][72][73][74][75][76][77]. Findings unrelated to epilepsy included empty sella, Chiari 1 malformation, and T2 hyperintensities consistent with multiple sclerosis [74,[78][79][80][81]. Incidental findings included, but were not limited to, pineal cysts without mass effect or edema [73,[82][83][84]. ...
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Objective Functional seizures often are managed incorrectly as a diagnosis of exclusion. However, a significant minority of patients with functional seizures may have abnormalities on neuroimaging that typically are associated with epilepsy, leading to diagnostic confusion. We evaluated the rate of epilepsy-associated findings on MRI, FDG-PET, and CT in patients with functional seizures. Methods We studied radiologists' reports from neuroimages at our comprehensive epilepsy center from a consecutive series of patients diagnosed with functional seizures without comorbid epilepsy from 2006 to 2019. We summarized the MRI, FDG-PET, and CT results as follows: within normal limits, incidental findings, unrelated findings, non-specific abnormalities, post-operative study, epilepsy risk factors (ERF), borderline epilepsy-associated findings (EAF), and definitive EAF. Results Of the 256 MRIs, 23% demonstrated ERF (5%), borderline EAF (8%), or definitive EAF (10%). The most common EAF was hippocampal sclerosis, with the majority of borderline EAF comprising hippocampal atrophy without T2 hyperintensity or vice versa. Of the 87 FDG-PETs, 26% demonstrated borderline EAF (17%) or definitive EAF (8%). Epilepsy-associated findings primarily included focal hypometabolism, especially of the temporal lobes, with borderline findings including subtle or questionable hypometabolism. Of the 51 CTs, only 2% had definitive EAF. Significance This large case series provides further evidence that, while uncommon, EAF are seen in patients with functional seizures. A significant portion of these abnormal findings are borderline. The moderately high rate of these abnormalities may represent framing bias from the indication of the study being “seizures,” the relative subtlety of EAF, or effects of antiseizure medications.
... The incidence over the period of study was 1.7%, which concurs with incidence reported in the literature [16][17][18][19]. Newborns with some degree of PVLM have a greater risk of presenting cerebral palsy and sensory deficit. ...
... In respect thereof, Imamura reported mental retardation in 50% and cerebral palsy in 83.6% [35]; 40% of quadriplegics achieved independent gait at 36 months with orthopedic braces, while 52% did not achieve independent gait. As observed, their results were not better than ours; 69% of their sample with PVLM grade 2 or 3 had IVH grade III o IV according to Papile [19]. ...
... Although affecting a small proportion of the infants, it was the second strongest predictor for cognitive development in the adverse outcomes' latent variable. Periventricular leukomalacia has also been reported as related to intellectual disability at different levels early 29 and later in life (poor intelligence quotient scores at 18 years old). 30 As an example, in a sample with 100 preterm infants, 27.8% of the infants with mild periventricular leukomalacia, 53.2% with moderate periventricular leukomalacia, and 77.1% with severe periventricular leukomalacia showed intellectual disability. ...
... 30 As an example, in a sample with 100 preterm infants, 27.8% of the infants with mild periventricular leukomalacia, 53.2% with moderate periventricular leukomalacia, and 77.1% with severe periventricular leukomalacia showed intellectual disability. 29 Yet, in the present study, the Apgar score was more reliable than mechanical ventilation in explaining the variance of the adverse outcomes in the model. Apgar scores less than 7, at the 5th minute of life, is associated with the increased risk of periventricular leukomalacia and the consequent neurologic impairments. ...
... Adverse outcomes were the most influential variables associated with motor development scores. Our results are similar to previous studies, in that preterm poor motor outcomes were related to periventricular hemorrhage, 10,15,16 periventricular leukomalacia, 29 low Apgar score at birth, 30 and mechanical ventilation. 4 Factors also associate with a higher risk for cerebral palsy, an outcome we did not assess here but plan to further investigate in the present sample longitudinally. ...
Article
Background This study extended previous research by investigating the combined effects of neonatal birth risks, neonatal adverse outcomes, and socioeconomic status on preterm neurodevelopment. Method A total of 184 preterm infants were assessed using the Bayley Scales of Infant Development III in a follow-up clinic in southern Brazil. Structural equation modeling was conducted with 3 latent variables (neonatal birth risks, neonatal adverse outcomes, and socioeconomic status) and 3 outcomes (cognitive, language, and motor development). Results The analyses showed that neonatal adverse outcomes were associated with infants’ cognitive (b = –0.45, P < .001), language (b = –0.23, P = .001), and motor (b = –0.51, P < .001) development. Socioeconomic status also explained the variances (cognitive: b = 0.20, P = .006; language: b = 0.28, P = .001; and motor: b = 0.21, P = .004), whereas neonatal birth risks remained significant only in the motor development (b = 0.15, P = .040). Conclusion This study suggests that the most evident contributors to poor neurodevelopment were adverse outcomes and socioeconomic risk factors.
... The intraventricular haemorrhage (IVH) is divided into four degrees of severity and ranges from bleeding in the germinal matrix to haemorrhagic infarction [18]. Periventricular leukomalacia (PVL) is caused by necrosis near the ventricles of the brain [19]. IVH and PVL was assessed by routine ultrasound of the brain. ...
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Objective Postnatal vitamin D supplementation is standard of care in neonates and preterm infants. Despite routine supplementation of vitamin D, a wide range of complications related to vitamin D deficiency has been described in the literature. Since standard vitamin D supplementation might be not sufficient in preterm infants with a genetic predisposition for vitamin D deficiency, we investigated the outcome of preterm infants with regard to their genetic estimated vitamin D levels. Methods Preterm infants with a birth weight below 1500 grams were included in the German Neonatal Network at the time of their birth and tested at the age of five. The vitamin D level was genetically calculated based on three single nucleotide polymorphisms (SNPs: rs12794714, rs7944926 and rs2282679) which alter vitamin D synthesis pathways. Specific alleles of these polymorphisms are validated markers for low plasma vitamin D levels. Outcome data were based on baseline data at the time of birth, typical complications of prematurity, body measurements at the age of five and occurrence of bone fractures. T-test and Fisher’s exact test were used for statistical comparison. Results According to their genetic predisposition, 1,924 preterm infants were divided into groups of low (gsVitD < 20. Percentile), intermediate and high vitamin D level estimates. Low genetic vitamin D level estimates could not be shown to be associated with any adverse outcome measures examined. The analyses covered data on aforementioned determinants. Conclusion Low genetic vitamin D level estimates could not be shown to be associated with previously described adverse outcome in preterm infants.
... In the preterm population, ADHD has been associated with reduced volumes in total cerebral and frontal areas (19,41), ventriculomegaly (42), and white matter injury (43). ASD and social-communicative problems have also been associated with brain abnormalities as defined by reductions in total cerebral volume (44) and in volumes of the frontal, occipital, and limbic regions (45,46), as well as periventricular leukomalacia (47), and other white matter abnormalities (44). Similarly, a potential explanation for increased anxiety and internalizing problems in the preterm population include white matter abnormalities (43) and reduced volume and connectivity in the amygdala (48)(49)(50)(51). ...
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Preterm birth is associated with a significantly increased risk for childhood and adolescent psychopathology relative to full-term birth, with an inverse relationship between gestational age at birth and later risk for psychopathology. The manifestation of symptomatology and comorbidity profiles of emotional and behavioral adjustment problems in this high-risk group have been shown to be distinct from the broader pediatric population. Acknowledging these differences, a preterm behavioral phenotype has been proposed and increasingly recognized, highlighting the unique, frequent co-occurrence of symptomatology associated with attention-deficit/hyperactivity disorder, autism spectrum disorder, and anxiety disorders. The current state-of-the-art review provides a comprehensive characterization of this phenotype to date and further highlights key knowledge gaps primarily regarding the evolution of symptoms, co-occurrence of disorders and/or symptomatology within the phenotype, and associations of the phenotype with chronological age and degree of prematurity.
... In these latter cases, typically seen but not exclusively in very preterm children, the extent and precise location of the cerebral damage is well correlated with the severity and pattern of the motor disability and associated impairments [25][26][27]. Gestational age seems per se to affect the clinical outcome, in particular regarding visuoperceptual abilities, but the extent of the brain lesion tends to outweigh the impact of the prematurity itself [28,29]. The degree of white-matter damage predicts not only motor dysfunction [30] but also visual impairment [31]. ...
Article
Background: Considerable effort has recently been made to improve the accurate diagnosis of cerebral palsy (CP) in childhood and to establish early intervention aiming to improve functional outcome. Besides the visible motor impairments, cognitive abilities are frequently affected but might remain unrecognised in children with mild forms. On the other hand, some severely disabled children with presumed intellectual disabilities might demonstrate normal-range reasoning capacities. Most studies on this topic have emphasized a variety of cognitive profiles (cognitive level) related to the type of cerebral palsy and the underlying brain lesions (biological level). However, little is known at the behavioural level, namely learning skills and educational achievement. Objective: This narrative review aimed to discuss cognitive and scholastic skills typically affected in children with CP. Methods: Online literature research for studies of cerebral palsy, cognition and academic achievement, extracting all relevant articles regardless of article type. Results: In children with CP, intellectual disability is frequent and correlated with the degree of motor impairment and early epilepsy. Speech and language problems are prevalent in all forms of CP and might hamper everyday participation on varying levels depending on the degree of motor disability. Most children with CP have neuropsychological deficits affecting predominantly visuospatial functions, attention, and/or executive functions. These problems relate to academic performance and social participation. Discussion: An adequate interdisciplinary follow-up of children with CP requires a sensitization of clinicians to the complex topic of cognitive and academic problems in this population and a better synergy between the medical and educational worlds.
... Mehrere Studien belegten, dass eine PVL ein erhöhtes Risiko sowohl für kognitive als auch motorische Defizite darstellt (Choi et al., 2016;Skiöld et al., 2012;Woodward et al., 2012). Choi et al. (2016) untersuchten 100 Frühgeborene mit GA <37 SSW mit magnetresonanztomographisch diagnostizierter PVL. ...
... Mehrere Studien belegten, dass eine PVL ein erhöhtes Risiko sowohl für kognitive als auch motorische Defizite darstellt (Choi et al., 2016;Skiöld et al., 2012;Woodward et al., 2012). Choi et al. (2016) untersuchten 100 Frühgeborene mit GA <37 SSW mit magnetresonanztomographisch diagnostizierter PVL. Dabei zeigten im Alter von 3-5 Jahren 67% (n=67) der Kinder eine Zerebralparese und 57% (n=57) der Kinder eine geistige Retardierung (Choi et al., 2016). ...
... Choi et al. (2016) untersuchten 100 Frühgeborene mit GA <37 SSW mit magnetresonanztomographisch diagnostizierter PVL. Dabei zeigten im Alter von 3-5 Jahren 67% (n=67) der Kinder eine Zerebralparese und 57% (n=57) der Kinder eine geistige Retardierung (Choi et al., 2016). ...
Thesis
Entwicklungsneurologischer Verlauf extrem Frühgeborener der Geburtsjahrgänge 2008 – 2013 des Perinatalzentrums Erlangen Ziele Analyse der kognitiven Entwicklung von extrem Frühgeborenen (<1000g, ELBW) im korrigierten Alter von 2 Jahren anhand der Bayley Scale of Infant Development II. Identifizierung neonataler Risikofaktoren, welche die spätere kognitive Entwicklung signifikant beeinflussen. Patienten und Methoden Die retrospektive Studie umfasst prä-, peri- und postnatale Daten von 51 Kindern (26w/25m) mit einem Geburtsgewicht <1000g und einem Gestationsalter zwischen 22 und 32 SSW, die im Zeitraum vom 1.Januar 2008 bis zum 31.Dezember 2013 im Perinatalzentrum der Universitätsklinik Erlangen geboren oder behandelt wurden. Im Rahmen der entwicklungsneurologischen Nachsorge Frühgeborener erfolgte im korrigierten Alter von 24 Monaten eine standardisierte Testung des kognitiven Entwicklungsstandes (MDI) mittels der Bayley Scales of Infant Development II. Die erhobenen neonatalen Faktoren wurden durch die Berechnung binärer logistischer Regressionen auf ihre Bedeutung für die kognitive Entwicklung hin überprüft. Ergebnisse Der Durchschnitts-MDI des gesamten Kollektivs lag bei 83. Bei der Nachsorgeuntersuchung zeigten 49.0% (n=25) der extrem Frühgeborenen einen unterdurchschnittlichen Mental Development Index (MDI)-Wert (<85). Extrem frühgeborene Kinder mit einem unterdurchschnittlichen MDI-Wert hatten ein statistisch signifikant niedrigeres Gestationsalter, ein signifikant niedrigeres Geburtsgewicht und eine signifikant kleinere Geburtslänge. Zudem wiesen sie signifikant häufiger eine Retinopathia praematurorum (ROP), bronchopulmonale Dysplasie (BPD) und kardiale Komplikationen auf. Ein binäres logistisches Regressionsmodell der Prädiktoren ROP, BPD, sozialer Status, kardiale Komplikationen, Geburtsgewicht und Gestationsalter zeigte die beste Varianzaufklärung für die kognitive Entwicklung (Nagelkerkes R²=0.076). Die Kombination dieser Einflussparameter –analysiert im Regressionsmodell- erlaubte in 88.0% der Fälle eine korrekte Zuordnung zur Gruppe der Kinder mit einem unterdurchschnittlichen MDI-Wert. Die Spezifität der Vorhersage in Bezug auf eine kognitiv normale Entwicklung liegt bei 86.4%. Schlussfolgerungen ELBW-Frühgeborene leiden im Kleinkindesalter unter einem erhöhten Risiko für kognitive Entwicklungsstörungen (49.0%). Im Erlanger Kollektiv der Jahrgänge 2008-2013 erwiesen sich als prognostische Faktoren für eine kognitive Entwicklungsstörung die Parameter ROP, BPD, sozioökonomischer Status, kardiale Komplikationen, Geburtsgewicht, Geburtslänge und Gestationsalter. Das Vorliegen einzelner oder mehrerer dieser Parameter erhöhte das Risiko für Entwicklungsdefizite im Alter von 2 Jahren signifikant. Besonders hervorzuheben ist, dass diese Studie den negativen Einfluss eines niedrigen sozioökonomischen Status belegt.
... 10 PVWL patients were subgrouped into three levels: mild (hyperintensity in periventricular white matter), moderate (hyperintensity+ventricular wall irregularity), and severe (diffuse PVWL+ventricular dilatation) according to our previous study. 22 The classification of brain MRI was performed by a neuroradiologist (Choi YS) who was blinded to the children's clinical condition. ...
... Recently, there have been emerging studies describing the wide range of motor or cognitive outcomes in children with PVWL or deep gray matter lesion in relation with the severity of brain lesion. 22,[30][31][32][33][34] Also, in present study, we noted wide range variability in communication function in children with PVWL. In addition, we discovered that the severity of PVWL was only related with SLPG. ...
... In addition, we discovered that the severity of PVWL was only related with SLPG. The significant negative effect of PVWL on cognitive functional outcome 22,31,35 and also significant associations between the severity of PVWL and cognitive function 22 have been published in prior studies. In this context, the results of our study can be explained by the greater focus of the SLPG on cognitive/ language impairment, compared to the VSS and CFCS. ...
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Purpose: The aim of the present study was to investigate communication function using classification systems and its association with other functional profiles, including gross motor function, manual ability, intellectual functioning, and brain magnetic resonance imaging (MRI) characteristics in children with cerebral palsy (CP). Materials and methods: This study recruited 117 individuals with CP aged from 4 to 16 years. The Communication Function Classification System (CFCS), Viking Speech Scale (VSS), Speech Language Profile Groups (SLPG), Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and intellectual functioning were assessed in the children along with brain MRI categorization. Results: Very strong relationships were noted among the VSS, CFCS, and SLPG, although these three communication systems provide complementary information, especially for children with mid-range communication impairment. These three communication classification systems were strongly related with the MACS, but moderately related with the GMFCS. Multiple logistic regression analysis indicated that manual ability and intellectual functioning were significantly related with VSS and CFCS function, whereas only intellectual functioning was significantly related with SLPG functioning in children with CP. Communication function in children with a periventricular white matter lesion (PVWL) varied widely. In the cases with a PVWL, poor functioning was more common on the SLPG, compared to the VSS and CFCS. Conclusion: Very strong relationships were noted among three communication classification systems that are closely related with intellectual ability. Compared to gross motor function, manual ability seemed more closely related with communication function in these children.