The report by Kidokoro et al in this issue of Pediatrics addresses the potential roles of electroencephalography in (1) diagnosis of periventricular leukomalacia (PVL) and (2) determination of its severity in premature infants (gestational age < 33 weeks). The authors concluded that to accomplish these goals, at least 2 electroencephalograms are needed, 1 within 48 hours of birth to detect “acute-stage abnormalities” (ASAs) and another in the second week of life to detect “chronic-stage abnormalities” (CSAs). The severity of both ASAs and CSAs correlated with the severity of PVL. The findings have implications for 2 major issues: (1) the diagnosis of PVL and (2) the timing of the insult(s) that led to the white-matter lesion.

Before addressing the 2 major issues just noted, it must be emphasized that the infants with PVL as defined in this study likely represent only the minority of premature infants with subsequent neurodevelopmental disability....

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