Impaired white matter development in extremely low-birth-weight infants with previous brain hemorrhage.
Impaired white matter development in extremely low-birth-weight infants with previous brain hemorrhage.
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DOI：
10.3174/ajnr.a3988
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发表时间：
2014-10
期刊：
影响因子：
--
通讯作者：
Kaiser JR
中科院分区：
文献类型：
--
作者：
Ou X;Glasier CM;Ramakrishnaiah RH;Mulkey SB;Ding Z;Angtuaco TL;Andres A;Kaiser JR
评价有或无脑出血史的极低出生体重儿（ELBW）的白色发育。33例ELBW婴儿前瞻性入组并纳入本IRB批准的研究。另取10例健康足月儿作为对照组。回顾超低出生体重儿的病历，以了解其脑室内出血（IVH）的超声诊断。所有婴儿在足月时均进行MRI检查，以检测既往出血情况，并对他们的白色物质进行评分，并在不同组中进行比较。DTI测量的各向异性分数（FA）值也比较了基于轨迹的空间统计（TBSS）的体素。与对照组相比，MRI上无血液沉积的ELBW婴儿的白色评分无显著差异（p=0.17），但在MRI显示有血液沉积但超声未诊断为IVH的ELBW婴儿中，（p=0.02），在超声检查为1级或2级IVH的ELBW婴儿中超声检查显示3级或4级IVH的ELBW婴儿（p = 0.0001）。MRI检查无血液沉积的ELBW婴儿未显示任何FA值显著低于对照组的白色物质区域。MRI上有血液沉积但未诊断IVH的ELBW婴儿确实显示FA显著较低的白色物质区域，诊断IVH的ELBW婴儿具有FA较低的广泛白色物质区域。在足月年龄的ELBW婴儿中，既往脑出血与异常白色物质相关，超声对足以引起白色物质损伤的轻微脑出血不敏感。
To evaluate white matter development in extremely low birth weight (ELBW) infants with or without previous brain hemorrhage. Thirty-three ELBW infants were prospectively enrolled and included in this IRB approved study. Another 10 healthy term infants were included as controls. The medical records of the ELBW infants were reviewed for ultrasound diagnosis of intraventricular hemorrhage (IVH). All infants had an MRI examination at term-equivalent age for detection of previous hemorrhage, and their white matter was scored and compared among different groups. DTI measured fractional anisotropy (FA) values were also compared voxel-wise by tract-based-spatial-statistics (TBSS). Compared to controls, the white matter score was not significantly different in ELBW infants without blood deposition on MRI (p=0.17), but was significantly worse in ELBW infants with blood deposition on MRI but no IVH diagnosis by ultrasound (p=0.02), in ELBW infants with grade 1 or 2 IVH on ultrasound (p=0.003), and in ELBW infants with grade 3 or 4 IVH on ultrasound (p=0.0001).ELBW infants without blood deposition on MRI did not show any white matter regions with significantly lower FA values than controls. ELBW infants with blood deposition on MRI but no IVH diagnosis did show white matter regions with significantly lower FA,and ELBW infants with IVH diagnosis had widespread white matter regions with lower FA. Previous brain hemorrhage is associated with abnormal white matter in ELBW infants at term-equivalent age, and ultrasound is not sensitive to minor hemorrhages that are sufficient to cause white matter injury.