Late neurologic and cognitive sequelae of inflicted traumatic brain injury in infancy
Late neurologic and cognitive sequelae of inflicted traumatic brain injury in infancy
复制标题
DOI：
10.1542/peds.2004-2739
复制
发表时间：
2005-08-01
期刊：
影响因子：
8
通讯作者：
Minns, RA
中科院分区：
文献类型：
--
作者：
Barlow, KM;Thomson, E;Minns, RA
Objective.关于创伤性脑损伤（TBI）的长期结果，包括摇晃婴儿综合征的信息有限。本研究的目的是描述在这一人群中观察到的长期神经、行为和认知后遗症。对1980年至1999年期间在苏格兰发生TBI的25名儿童进行了横断面和前瞻性纵向研究。在获得同意后，对所有参与者进行神经和认知检查，并在前瞻性队列中按顺序进行。使用了两种总体结局指标：格拉斯哥结局评分（GOS）和Seshia结局评分。认知结果采用Bayley婴儿发展量表、英国能力量表和Vineland适应行为量表进行评估。平均随访时间为59个月。共有68%的幸存者在随访时出现异常，36%有严重困难，完全依赖，16%有中度困难，16%有轻度困难。观察到广泛的神经系统后遗症，包括运动缺陷（60%）、视觉缺陷（48%）、癫痫（20%）、言语和语言异常（64%）和行为问题（52%）。认知能力的范围很广：平均精神发育指数为69.9（SD：+/- 25.73）;平均智力发育指数为74.53（SD：+/- 28.55）。适应功能在所有领域都表现出广泛的困难：沟通领域（平均值：76.1; SD：+/- 25.4），日常生活技能领域（平均值：76.9; SD：+/- 24.3）和社会化领域（平均值：79.1; SD：+/- 23.1）。结果发现与小儿创伤评分和格拉斯哥昏迷评分相关，但与受伤时的年龄或受伤机制无关。创伤性脑损伤的预后非常差，并且与损伤的严重程度相关。有必要进行长期跟踪，以免低估儿童在上学后才可能出现的具体学习困难以及注意力和记忆力问题。行为问题存在于52%，开始表现为临床之间的第二和第三年的生活，虽然额叶损伤的后果可能被低估，除非后续延长到青春期和成年早期。
Objective. There is limited information regarding the long-term outcome of inflicted traumatic brain injury ( TBI), including shaken infant syndrome. The purpose of this study was to describe the long-term neurologic, behavioral, and cognitive sequelae seen in this population.Methods. A cross-sectional and prospective longitudinal study was conducted of 25 children with inflicted TBI in Scotland between 1980 and 1999. After consent was obtained, neurologic and cognitive examinations were performed on all participants and sequentially in the prospective cohort. Two global outcome measures were used: Glasgow Outcome Score (GOS) and Seshia's outcome score. Cognitive outcome was assessed using the Bayley Scales of Infant Development, British Ability Scales, and the Vineland Adaptive Behavior Scales.Results. The mean length of follow-up was 59 months. A total of 68% of survivors were abnormal on follow-up, 36% had severe difficulties and were totally dependant, 16% had moderate difficulties, and 16% had mild difficulties on follow-up. A wide range of neurologic sequelae were seen, including motor deficits (60%), visual deficits (48%), epilepsy (20%), speech and language abnormalities (64%), and behavioral problems (52%). There was a wide range of cognitive abilities: the mean psychomotor index, 69.9 ( SD: +/- 25.73); and mean mental development index, 74.53 ( SD: +/- 28.55). Adaptive functioning showed a wide range of difficulties across all domains: communication domain (mean: 76.1; SD: +/- 25.4), Daily living skills domain ( mean: 76.9; SD: +/- 24.3), and socialization domain ( mean: 79.1; SD: +/- 23.1). Outcome was found to correlate with the Pediatric Trauma Score and the Glasgow Coma Score but did not correlate with age at injury or mechanism of injury.Conclusions. Inflicted TBI has a very poor prognosis and correlates with severity of injury. Extended followup is necessary so as not to underestimate problems such as specific learning difficulties and attentional and memory problems that may become apparent only once the child is in school. Behavioral problems are present in 52% and begin to manifest clinically between the second and third years of life, although the consequences of frontal lobe injury may be underestimated unless followup is extended into adolescence and early adulthood.