Cystic periventricular leukomalacia in preterm infants: Clinical risks and heart rate and oxygenation patterns

Abstract Objective: Cystic periventricular leukomalacia (cPVL) is a major cause of neurodevelopmental impairment in preterm infants, yet associated clinical and physiologic variables remain incompletely defined. We sought to identify differences in maternal and infant clinical variables, including patterns of heart rate (HR) and oxygen saturation (SpO₂) in the first six weeks after birth, in infants with cPVL compared to matched controls. Study Design: We conducted a single-center, retrospective study of infants admitted to a level IV NICU 2012–2022. Infants with cPVL were matched 1:1 with controls by sex, gestational age, and birth year. Clinical variables were extracted from institutional databases. Hourly averages of HR and SpO₂ mean, standard deviation, skewness, and kurtosis were calculated from 0.5 Hz data from standard NICU monitors from birth to day 42, and compared for infants with and comparisons. without cPVL. Continuous variables were compared with t-tests, categorical variables with χ² tests, and time-series HR and SpO2 metrics with t-tests using Bonferroni correction for multiple Results: Nineteen infants with cPVL and 19 matched controls were identified. Maternal characteristics were similar between groups. A higher percentage of infants with cPVL received vasopressor support and were more likely to receive hydrocortisone therapy while other morbitidies and blood gas values were comparable between groups. In the cPVL group, General Movement Assessment was abnormal in all infants who had it performed and cerebral palsy occurred more frequently. There were no consistent differences in HR metrics in the 42 day period. Infants with cPVL had consistently higher mean SpO2 but also more negative skewness (more desaturations) and higher kurtosis (more outlier values), implying more swings from low to high SpO2. Conclusion: In this cohort, cPVL was associated with treatment for hypotension and sustained differences in SpO₂ after birth, suggesting more oxidative stress. Further work is needed to determine how SpO₂ dynamics reflect, predict, or perhaps contribute to cPVL