Isolated parenchymal lesions on cranial ultrasound in very preterm infants in the context of maternal infection
Abstract
Aim
To explore the associations between a clinical diagnosis of maternal infection (CDMI) and findings on the initial cranial ultrasound scan in very preterm infants.
Methods
Among infants born at less than 32 weeks gestation, cases of CDMI and controls were identified on the basis of routinely available obstetric data. Neonatal cranial ultrasound scans carried out soon after birth were retrospectively reviewed for evidence of parenchymal echodensity (PED), intraventricular haemorrhage (IVH) or PED contiguous with IVH.
Results
Any PED was identified in 20/40 (50%) cases of CDMI and 9/30 (30%) of controls. Logistic regression was used to adjust for differences between the two study groups. When compared with normal scans, isolated PED was more likely with CDMI odds ratio, OR (95% confidence interval, CI), 41.8 (2.64, 662) and lower Apgar score at 5 min 2.89 (1.05, 7.98). IVH was more likely with lower gestational age, OR for each completed week of gestation 0.64 (0.46, 0.88) and a protective effect of female sex, OR 0.25 (0.063, 0.98), PED contiguous with IVH was more likely with lower gestational age OR 0.59 (0.336, 1.04).
Conclusions
CDMI may be associated with isolated PED in very preterm infants. We speculate that isolated PED (including “flares”) identify infants who have sustained early brain injury because of intrauterine infection. Isolated PED may be a useful intermediate outcome in perinatal cohort studies.
aAcademic Unit of Child Health, University of Manchester, UK
bDepartment of Obstetrics and Gynaecology, St. Mary's Hospital, Hathersage Road, Manchester M13 0JH, UK
cDepartment of Paediatrics, St. Mary's Hospital, Hathersage Road, Manchester M13 0JH, UK
dDepartment of Clinical Radiology, St. Mary's Hospital, Hathersage Road, Manchester M13 0JH, UK
eDepartment of Neonatal Medicine, St. Mary's Hospital, Hathersage Road, Manchester M13 0JH, UK
Corresponding author. University of Liverpool, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK. Tel.: +44 151 702 4118; fax: +44 151 702 4024.
ABSTRACT