622 - Periventricular leukomalacia: relationship to intraventricular hemorrhage, change overtime, predisposing factors, and associated comorbidities

Publication Number: 622.6475

Mohsen A.A.. Farghaly, Cleveland Clinic Children's, Cleveland, OH, United States; Seohyun Cho, Cleveland Clinic Children's, Cleveland, OH, United States; Alshimaa A.. Abdalla, Nassau University Medical Center, New York, NY, United States; Nicole Buzalka, Cleveland Clinic Children's, cleveland, OH, United States; Hany Aly, Cleveland Children’s Hospital, Cleveland, OH, United States; Mohamed A. Mohamed, Cleveland Clinic Children's, Cleveland, OH, United States

Background: Periventricular leukomalacia (PVL) is a devastating adverse outcome of prematurity. The pathogenesis of PVL is multifaceted. Potential underlying mechanisms include cerebral hypoperfusion injury, or the aftermath of cerebral hemorrhage or grade 4 intraventricular hemorrhage (IVH).

Objective: To examine the association of IVH with PVL, changes in the prevalence of PVL over the years, risk factors and health disparities in association with PVL in preterm infants.

Design/Methods: This study used the national datasets produced by the Healthcare Cost and Utilization Project (HCUP) in 2010-2020. We used the International Classification of Diseases- versions 9 (ICD9) and 10 (ICD10) codes to identify required variables. We included all infants < 1500g birth weight (BW). We excluded infants with central nervous system anomalies, congenital heart diseases, diaphragmatic hernia, lung anomalies, abdominal wall defects, multiple congenital anomalies, and common chromosomal disorders. We excluded infants who died within the first 48 hours of life. We used logistic regression models to calculate adjusted odds ratios (OR) to control for confounders. We used Chi square test to trend changes over time.

Results: The study included 400,892 newborn infants. There were 67,479 (16.8%) infants with IVH, of them, 50,184 (12.5%) with grade 1-2 IVH and 17,295 (4.31%) with grades 3-4 IVH. There were 6330 (1.56%) infants with PVL. Infants with IVH had 3355 (4.97%) PVL compared to 3006 (0.89%) in infants without IVH, aOR 4.24 (95%CI:4.02-4.47), p< 0.001. Compared to infants without IVH, those with grades 1-2 IVH had 1540 (3.07%) PVL, aOR 2.63 (2.46-2.80), p< 0.001, while infants with severe IVH had 1815 (10.5%) PVL, aOR 8.63 (8.05-9.26), p< 0.001. There was no significant change in the prevalence of IVH or severe IVH over the years. Although, the prevalence of the overall PVL and PVL without IVH slightly declined, p < 0.01, the prevalence of PVL associated with IVH Grade 1-2 or Grade 3-4 did not change, Figure (1). Factors associated with PVL included prolonged mechanical ventilation, apnea and anemia of prematurity, pulmonary hemorrhage or hypertension, sepsis and NEC. The prevalence of PVL among Caucasians, African Americans, Hispanic/Latinos, Asian/Pacific Islanders, or Native Americans, were 1.59%, 1.74, 1.47, 1.18, and 0.84, respectively.

Conclusion(s): Although PVL is highly associated with Grade 3-4 IVH, it also occurs in association with Grade 1-2 or no IVH. Close follow up is indicated in cases of no or mild IVH to not miss PVL diagnosis. Further research is indicated to explore the pathogenesis of PVL with or without IVH.

Figure (1): Change in the prevalence of intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) over the years of the study.