Periventricular Leukomalacia

Periventricular Leukomalacia Periventricular leukomalacia is the most common ischemic brain injury in premature infants. It is not a congenital condition, but a severe variant of the brain. The disease begins as focal necrosis of the cerebral white matter around the lateral ventricles, followed by the subsequent formation of cysts. Over time, the condition can progress into more diffuse injury to the white matter. Damage to the brain tissue as a result of periventricular leukomalacia can lead to serious consequences for the affected neonate. It is associated with the development of cerebral palsy, intellectual impairment, and disturbances of vision, hearing, and speech. Though the pathology can be seen in later preterm and term infants, it

The most significant risk factor is premature birth, particularly prior to 32 weeks. Low birth weight, below 1500 grams, is also a significant risk factor for periventricular leukomalacia. It is believed that this is due to the immaturity of the cerebral vasculature; until the brain is fully developed, it is more susceptible to injury. Maternal infection during pregnancy can also increase the risk that periventricular leukomalacia. Insults to the brain as a result of infection can lead to injury of the cerebral white matter. Additionally, infants on mechanical respiration may develop hyocarbia. Hypocarbia, particularly within the first week of life, appears to be linked to the development of periventricular leukomalacia.
Periventricular leukomalacia is often detected during a routine sonogram of a premature infant. However, if it is not detected shortly after birth, the patient can present with a number of clinical signs. Clinical signs of periventricular leukomalacia include seizures, apnea, abnormal muscle tone, and leg weakness. Other clinical presentations of periventricular leukomalacia include cerebral palsy, intellectual disability, or visual disturbances. Cerebral palsy is observed in more than half of patients with periventricular

Strategies to prevent the development of this condition emphasize the maintenance of cerebral perfusion. The patient’s blood pressure and blood gases are carefully monitored, and any abnormalities are corrected. If periventricular leukomalacia develops, treatment is directed toward the management of any subsequent complications. Caregivers are taught how to properly handle, feed, dress, and toilet their children. Physical therapy is prescribed when abnormal physical signs become apparent in order to prevent secondary deformities. After discharge, patients are carefully monitored for any other conditions that arise as a result of periventricular leukomalacia. If complications develop, treatment is geared toward those specific conditions, rather than periventricular