467 - Perinatal Risk Factors for Lenticulostriate Vasculopathy in Extremely Preterm Population.

Poster Number: 467
Publication Number: 467.342

Chaitra Manjunath, University of South Alabama Children's and Women's Hospital, Mobile, AL, United States; Fabien Eyal, University of South Alabama, Mobile, AL, United States; Michael Zayek, University of South Alabama College of Medicine, Mobile, AL, United States; Kalsang Dolma, University of South Alabama, Mobile, AL, United States

Background: Recent studies have described the increased incidence of lenticulostriate vasculopathy (LSV) in extremely preterm (EP) infants. However, limited data is available on perinatal risk factors, neurodevelopmental outcome, and the overall significance of LSV in EP infants.

Objective: 1. To identify the incidence and perinatal risk factors associated with LSV in EP infants.
2. To describe the association between the cranial ultrasound findings with 2-year neurodevelopmental outcome or death

Design/Methods: In this retrospective, single center study, neonates who were born between January 2014 and December 2020 with a gestational age (GA) of ≤ 28 weeks were included. Infants with major congenital anomalies were excluded. Infants with a diagnosis of LSV were identified (LSV group) and compared with remaining infants (control).

Results: LSV was detected in 84 (11 %) infants out of the 793 EP infants. LSV was predominant in infants who are more immature and have lower birth weights (BW), p < 0.001. (Figure 1) All LSV were detected at a postmenstrual age (PMA) ≥ 28 weeks. Overall, the timing of LSV detection ranged from a PMA of 28 to 48 weeks. Sonographic detection of LSV occurred sooner in the more mature infants with GA of 25-28 weeks (n=38) at a median (IQR) postnatal age (PNA) of 45 (42-85) days and PMA of 33 (32-38) weeks than in infants with GA of 22-24 weeks (n=46) at PNA of 96 (84-112) days and PMA 37 (35-39) weeks, p < 0.001. Only infants who survived beyond a PMA of 28 weeks (n=712) were included in further statistical analysis. On multivariate regression analysis, presence of LSV in EP infants remained significantly associated with lower GA, lower BW, intratracheal instillation of budesonide in combination with the exogenous surfactant, sepsis, prolonged duration of hydrocortisone for > 30 days, congenital CMV infection, maternal tobacco uses and hypertension. Other common NICU morbidities such as bronchopulmonary dysplasia and necrotizing enterocolitis were not significantly associated with increased rates of LSV. Lower GA and prolonged duration of mechanical ventilation associated with the delayed detection of LSV beyond 36 weeks PMA, p < 0.01. There was no difference in death or neurodevelopmental impairment at 18-24 months between infants with LSV or without LSV. (Figure 2)Conclusion(s): In extremely preterm infants, LSV could be a benign finding. Further investigations are warranted to substantiate our results.
Perinatal Risk Factors for Lenticulostriate Vasculopathy in Extremely Preterm PopulationFigure 1: Rates of LSV by birth weight in infants who survived to 28 weeks
Perinatal Risk Factors for Lenticulostriate Vasculopathy in Extremely Preterm PopulationFigure 2: Death or neurodevelopmental impairment at 2 years