Perinatal Risk Factors for Lenticulostriate Vasculopathy in Extremely Preterm Population

Background: Recent studies have described increased incidence of lenticulostriate vasculopathy (LSV) in extremely preterm infants. However, factors associated with the development of LSV in this population are still unclear and need to be further elucidated.

The aim of our study is to identify the prevalence, risk factors, timing, progression, and resolution of LSV in a population of EP infants.

Methods:

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. All LSV were detected at a postmenstrual age (PMA) ≥ 28 weeks. Only infants who survived beyond a PMA of 28 weeks (n=712) were included in further statistical analysis. LSV was predominant in infants who are more immature and have lower birth weights (BW), p<0.001. These rates of LSV are illustrated in figure 1. 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 exogenous surfactant, absence of fetal exposure to tobacco, type-2 retinopathy of prematurity, and intact white matter (WM). Other common NICU morbidities such as bronchopulmonary dysplasia and necrotizing enterocolitis were not significantly associated with increased rates of LSV. We also found that 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 96 (84-112) days and PMA 37 (35-39) weeks, p< 0.001. Lower GA and prolonged duration of mechanical ventilation associated with the delayed detection of LSV beyond 36 weeks PMA, p<0.01.

Conclusion: Degree of immaturity and less acute postnatal morbidity seem to be the major factors associated with development of LSV. Most importantly, the neurodevelopmental impact of LSV will be evaluated in further study.