Impaired cerebral cortical gray matter growth after treatment with dexamethasone for neonatal chronic lung disease
Impaired cerebral cortical gray matter growth after treatment with dexamethasone for neonatal chronic lung disease
复制标题
DOI：
10.1542/peds.107.2.217
复制
发表时间：
2001-02-01
期刊：
影响因子：
8
通讯作者：
Volpe, JJ
中科院分区：
文献类型：
--
作者：
Murphy, BP;Inder, TE;Volpe, JJ
Objective.本研究的具体目的是量化出生后全身地塞米松治疗新生儿慢性肺部疾病对随后的脑生长发育的影响，这些早产儿没有严重脑室内出血或白色物质损伤的证据。18名早产儿（23 - 31周），7名接受地塞米松治疗，11名未接受治疗，在足月时，即孕后38 - 41周，通过先进的定量体积三维磁共振成像（MRI）技术对脑组织体积进行定量研究。14名健康足月婴儿也进行了比较研究。使用一系列图像处理算法将每个MRI切片分割为以下单独的组织类别：大脑皮质灰质、基底神经节/丘脑、无髓鞘白色物质、有髓鞘白色物质和脑脊液，所有这些均基于磁共振信号强度和解剖位置进行分类。对每个组织类别的体素进行最终求和，以计算绝对体积（单位：毫升）。与未接受地塞米松治疗的早产儿相比，接受地塞米松治疗的早产儿大脑皮质灰质体积减少了35%（平均值+/-标准差分别为130.3 +/- 54.0 vs 200.6 +/- 35.1 mL）。皮质下灰质体积（基底神经节和丘脑）和有髓和无髓白色物质体积在处理组和未处理组之间没有显著差异。然而，与未接受地塞米松治疗的早产儿和对照足月儿的总脑组织体积相比，接受地塞米松治疗的早产儿的总脑组织体积减少（30%）（分别为312.7 +/- 43.7 vs 448.2 +/- 50.2和471.6 +/- 36.4 mL）。后一项发现主要与大脑皮质灰质体积的减少有关。数据表明，继发于全身地塞米松治疗的脑生长受损，主要影响大脑皮质灰质。尽管接受地塞米松治疗的早产儿体型较小，呼吸系统疾病更严重，但这些发现与越来越多的证据一致，即地塞米松对新生儿大脑和随后的神经发育结局具有潜在的有害影响。临床医生在权衡这种治疗对患有新生儿慢性肺病的低出生体重儿的潜在风险和益处时，应考虑到这种明显的有害作用。
Objective. The specific aim of this study was to quantify at term the influence of postnatal systemic dexamethasone treatment for neonatal chronic lung disease on subsequent brain growth and development in premature infants without evidence of severe intraventricular hemorrhage or white matter injury.Methods. Eighteen premature (23 to 31 weeks) infants, 7 treated with dexamethasone and 11 not treated, were studied at term, ie, 38 to 41 postconceptional weeks, by an advanced quantitative volumetric 3-dimensional magnetic resonance imaging (MRI) technique to quantify cerebral tissue volumes. Fourteen healthy term infants also were studied for comparison. A sequence of image processing algorithms was used to segment each of the MRI slices into the following separate tissue classes: cerebral cortical gray matter, basal ganglia/thalami, unmyelinated white matter, myelinated white matter, and cerebrospinal fluid, all classified based on magnetic resonance signal intensity and anatomic location. A final summing of voxels for each tissue class was performed to compute absolute volumes in milliliters.Results. Cerebral cortical gray matter volume in premature infants treated with dexamethasone was reduced 35% when compared with gray matter volume in premature infants not treated with dexamethasone (mean +/- standard deviation, 130.3 +/- 54.0 vs 200.6 +/- 35.1 mL, respectively). Subcortical gray matter volumes (basal ganglia and thalami) and myelinated and unmyelinated white matter volumes were not significantly different among the treated and untreated groups. However, premature infants treated with dexamethasone exhibited a reduction (30%) in total cerebral tissue volume compared with total cerebral tissue volume in both the premature infants not treated with dexamethasone and the control term infants (312.7 +/- 43.7 vs 448.2 +/- 50.2 and 471.6 +/- 36.4 mL respectively). This latter finding relates primarily to the decrease in cerebral cortical gray matter volume.Conclusions. The data suggest an impairment in brain growth, principally affecting cerebral cortical gray matter, secondary to systemic dexamethasone therapy. Although the premature infants who received dexamethasone were smaller with more severe respiratory disease, these findings are consistent with growing evidence of a potential deleterious effect of dexamethasone on neonatal brain and subsequent neurodevelopmental outcome. This apparent deleterious effect should be taken into consideration by clinicians when weighing the potential risks and benefits of this therapy for low birth weight infants with neonatal chronic lung disease.