Anemia of Prematurity - Portal Neonatal

FOLLOW-UP Section 7 of 10
Further Outpatient Care:
• Developmental follow-up: Premature infants with evidence of PVL require close developmental
follow-up because of the high association with CP.
Deterrence/Prevention:
• Prevention of premature birth is the most important means of preventing PVL.
• Prior to birth, diagnosing and managing chorioamnionitis may prevent PVL. In 1999, Baud et al
reported that betamethasone administered to mothers at 24-31 weeks' gestation, before
delivery, significantly reduced the risk of PVL, suggesting the possible effect of steroids on fetal
inflammatory response.
• Avoiding maternal cocaine abuse and avoiding maternal-fetal blood flow alterations has been
suggested to minimize PVL.
• Following delivery of a premature infant, attempts to minimize blood pressure (BP) swings and
hypotension may also be beneficial in preventing PVL.
• Avoidance of prolonged hypocarbia in the mechanically premature infant may be useful in the
prevention of PVL.
Prognosis:
• Infants with PVL are at risk for development of neurodevelopmental deficits. Mild PVL is often
associated with spastic diplegia. Severe PVL is associated with quadriplegia. Severe PVL is
also associated with a higher incidence of intelligence deficiencies and visual disturbances.
MISCELLANEOUS Section 8 of 10
Medical/Legal Pitfalls:
• Timing of initial cranial ultrasonography can be useful in determining the timing of the insult.
Cystic PVL has been identified on cranial ultrasounds on the first day of life, indicating that the
event was prenatal rather than perinatal or postnatal.
PICTURES Section 9 of 10
Picture 1. Cranial ultrasound, coronal view, in 1-week-old premature infant. The periventricular
echotexture is abnormally increased (greater than or equal to that of the choroid plexus), which is
consistent with the early changes of periventricular leukomalacia (PVL). Courtesy of Matthew
Omojola, MD.