[Respiratory distress syndrome, early postnatal corticoid therapy and periventricular leukomalacia].

UNLABELLED: The aetiology of cavitating periventricular leukomalacia (cPVL) involves pre and perinatal factors. Early postnatal dexamethasone has been associated with an increase in cerebral palsy but its role in the development of PVL remains uncertain.

OBJECTIVES: (1) Reevaluate major factors associated with cPVL, (2) Evaluate the potential effect of early postnatal dexamethasone.

METHOD: This retrospective case-control study (matched for gestational age, birth weight, twin pregnancy and date of birth) compared 50 premature infants with cPVL diagnosed between D7 and D45 from 1995 to 2000 and 50 matched control newborns with normal serial neurosonograms. A data base with 97 selected perinatal variables was used to perform logistic regression analysis in controlling confounding variables, the results are expressed as adjusted Odds Ratio (OR) with 95% confidence interval.

RESULTS: The two populations were comparable for gestational age (median: 29.3 weeks, range: 24.4-34.7) and birth-weight (1297 g, 645-2130 g). The annual incidence of cPVL in preterm infants with a gestational age < 33 weeks varied from 1995 to 2000: 1.3%, 4.5%, 13.4%, 2.1%, 3%, 2.9%. Early postnatal dexamethasone was used in 23 of the newborns who developed cPVL (between november 1996 and march 1998). The only antenatal factor associated with cPVL was cardiac decelerations (28% vs 14%, OR = 3.4, 1.1-11.3). The postnatal risk factors were respiratory distress syndrome requiring the use of rescue surfactant (78% vs 38%, OR = 4.2, 1.4-11.9) and early postnatal dexamethasone at the time it was used (78% vs 17%, OR = 17.1, 3.9-73).

CONCLUSION: The use of rescue surfactant and of early postnatal dexamethasone in preterm infants with respiratory distress syndrome were independently associated with the subsequent occurrence of cPVL. Cardiac deceleration was the only antenatal factor associated with cPVL.