From the Guidelines
Periventricular calcifications in neonates are a significant indicator of congenital infection, most commonly caused by cytomegalovirus (CMV), and require immediate comprehensive workup and potential treatment to mitigate long-term neurodevelopmental risks. The presence of these calcifications often signifies areas of brain tissue damage and mineralization following intrauterine infection, typically occurring during the second or third trimester when brain development is critical 1.
Diagnostic Approach
When periventricular calcifications are identified, a thorough diagnostic workup should be initiated, including:
- Serologic testing for TORCH infections (Toxoplasmosis, Other infections, Rubella, Cytomegalovirus, and Herpes simplex virus)
- PCR testing of blood, urine, and possibly cerebrospinal fluid
- Additional neuroimaging such as MRI to better characterize the extent of brain involvement
Treatment Considerations
Treatment depends on the identified pathogen; for CMV, ganciclovir (6 mg/kg/dose IV every 12 hours) or oral valganciclovir (16 mg/kg/dose twice daily) for 6 months may be indicated, particularly if there is evidence of active disease or neurological symptoms 1. For toxoplasmosis, pyrimethamine, sulfadiazine, and leucovorin are typically used.
Long-term Implications
The presence of periventricular calcifications is associated with an increased risk of developmental delay, cerebral palsy, epilepsy, and sensory impairments, underscoring the importance of long-term neurodevelopmental follow-up 1, 1.
Key Considerations
- Cytomegalovirus (CMV) is one of the most frequent non-genetic causes of malformations of cortical development and is specifically associated with polymicrogyria, intracranial calcifications, white matter abnormalities, and microcephaly 1.
- Other infectious agents, including rubella virus, varicella zoster, and herpes simplex virus, can also cause microcephaly and should be considered in the diagnostic workup 1.
From the Research
Implications of Periventricular Calcifications in Newborns
- Periventricular calcifications in newborns can be associated with various conditions, including infectious, congenital, endocrine/metabolic, vascular, and neoplastic causes 2, 3
- Infections, especially neonatal TORCH (toxoplasmosis, other [syphilis, varicella-zoster, parvovirus B19], rubella, cytomegalovirus, and herpes) infections, are common causes of intracranial calcification in the neonatal period 2
- Hypoxic-ischemic encephalopathy is a significant cause of mortality and morbidity in newborns, and periventricular calcifications can be a consequence of this condition 4, 5
- The presence of periventricular calcifications can be an indicator of underlying brain injury, and the severity of the injury can vary depending on the intensity and duration of hypoxia-ischemia 5
- Therapeutic hypothermia has been shown to reduce the incidence of hypocalcemia and increase the incidence of hypercalcemia in neonates with hypoxic-ischemic encephalopathy, which may have implications for the development of periventricular calcifications 6
Diagnostic and Prognostic Considerations
- Age at presentation, intracranial calcification location, and associated neuroimaging findings are important factors in narrowing the differential diagnosis of periventricular calcifications 2, 3
- Neuroimaging modalities such as CT and MRI can be used to detect periventricular calcifications, and the choice of modality depends on the specific clinical scenario 2
- The prognosis of newborns with periventricular calcifications depends on the underlying cause and severity of the condition, as well as the presence of any associated neurodevelopmental abnormalities 4, 5
Clinical Management
- Management of periventricular calcifications in newborns depends on the underlying cause and may involve specific treatments such as anticonvulsant drugs, therapeutic hypothermia, or supportive care 6, 4
- Close monitoring of serum calcium levels and other electrolytes is important in newborns with periventricular calcifications, especially those with hypoxic-ischemic encephalopathy 6