Frequency and prognostic significance of germinal matrix hemorrhage, periventricular leukomalacia, and pontosubicular necrosis in preterm neonates.

The occurrence of germinal matrix hemorrhage (GMH), periventricular leukomalacia (PVL), and pontosubicular necrosis (PSN) was evaluated in a material of 96 preterm infants. All cases were born at less than 38 weeks of gestation, and died within 30 days after birth. The frequency of GMH (50%) and PVL (24%) was within the range of previous observations, but the 59% occurrence of PSN argues against the assertion that intraventricular hemorrhage is the most common neuropathological finding in preterm neonates. However, different combinations of these injuries were found in more than half the cases affected. Of the 48 infants with GMH, 36 (75%) showed either PSN (19 cases), PVL (2 cases), or both lesions (15 cases), and the frequency of additional damage was related to the severity of hemorrhage. Thus, neonatal mortality may be more related to additional hypoxic/ischemic lesions than to the severity of hemorrhage per se. Clinical follow-up studies on subpopulations of preterm infants with and without GMH have shown no difference in frequency of mild and moderate psychomotoric deficiencies. The 35% occurrence of PSN as a solitary lesion in the 48 cases without GMH was similar to the frequency of PSN as a single additional lesion in 48 cases with GMH (40%). This finding makes PSN and not GMH the most likely cause of at least less severe handicaps.