Cystic periventricular leukomalacia (PVL) is a severe form of white matter injury predominantly affecting preterm infants and a leading cause of neurodevelopmental disorders, such as cerebral palsy, cognitive impairment, and epilepsy. While fetal inflammatory response syndrome (FIRS) has been implicated in PVL pathogenesis, the association between interleukin-6 (IL-6) dynamics and cystic PVL development remains unclear. We report a late preterm female newborn (34 0/7 weeks' gestation) delivered following maternal fever onset. Despite an uncomplicated delivery and stable postnatal systemic condition, the infant exhibited early leukopenia, elevated C-reactive protein, and strikingly high serum IL-6 levels: 84,690 pg/mL in cord blood, 139,500 pg/mL at 2 h, and 15,840 pg/mL at 6 h after birth. Cranial magnetic resonance imaging (MRI) on day 7 (corrected gestational age of 35 0/7 weeks) demonstrated bilateral periventricular white matter abnormalities, with follow-up imaging on day 21 revealing evolution into cystic PVL. By 4 months corrected age, the infant developed West syndrome. At 2 years, she exhibited spastic paralysis with a developmental quotient of 36. This case represents, to our knowledge, the first report to document dynamic postnatal IL-6 elevation in a newborn with cystic PVL confirmed by early postnatal MRI, particularly diffusion-weighted imaging, in diagnosing and delineating white matter injury. Despite the absence of most known risk factors for cystic PVL, this case underscores the critical role of FIRS in its pathogenesis. Early IL-6 monitoring and advanced imaging modalities may aid in timely PVL detection, while also offering clues to its underlying pathogenesis.
Kobayashi et al. (Sat,) studied this question.