Prognosis of periventricular leukomalacia in newborns with very low and extremely low body weight
The objective. To work out criteria for prognosis of development of periventricular leukomalacia (PVL) in newborns with very low and extremely low body weight. Patients and methods. The study included 32 children with cystic PVL (basic group) and 60 children without such (control group). Prognosis was built on A.Wald's sequential analysis with calculation of prognostic indices (PI) and informativity. Results. As has been found, the greatest prognostic value for assessment of a risk for development of cystic PVL (PI = +6.2) belongs to the pathological character of amniotic fluid (turbid, meconium-stained, tinged with blood), which most often combined with the presence of urogenital infection (PI = +3.0) and chorioamnionitis in pregnant women (PI = +3.6). Also, risk factors have been determined as follows: convulsive syndrome (PI = +7.8); hypotension and haemorrhagic syndrome (PI = +4.9); severe respiratory distress syndrome and anaemia (PI = +2.5); pneumonia or sepsis (PI = +3.5); laboratory signs of systemic inflammatory response (PI = +6.6); levels of рСО <sub>2</sub> < 30 mm Hg (PI = +7.1) and рО <sub>2</sub> > 70 mm Hg (PI = +3.0); НСО <sub>3</sub> < 20 mm Hg (PI = +4.9); ВЕ < 4 mmol/l (PI = +2.3); IL-6 > 25 pg/ml (PI = +1.6) and ^-1РА > 550 pg/ml (PI = +2.0). Protectors of favourable outcomes were Apgar scores > 7 at the 5 <sup>th</sup> min (PI = -4.5); absence of ALV during the 1 <sup>st</sup> week of life (PI = -3.9), uncomplicated course of RDS (PI = -2.4), absence of signs of SBS (PI = -1.6), levels of рСО <sub>2</sub> ≥ 30 mm Hg (PI = -2.7), НСО <sub>3</sub> > 20 mmol/l (PI = -3.7), ВЕ > -4 mmol/l (PI = -2.5); values of IL-6 ≤ 25 pg/ml (PI = -3.6) and IL-1РА ≤ 550 pg/ml (PI = -5.4). Conclusion. Mathematical interpretation of clinical-anamnestic risk factors and laboratory data creates a real possibility of making an individual prognosis for formation of cystic PVL in newborns with very low and extremely low body weight. This approach permits, as soon as in the first days of a child's life, targeted prevention or correction of arising pathological conditions associated with PVL.