Predictive value of neonatal MRI showing no or minor degrees of brain injury after hypothermia.
Predictive value of neonatal MRI showing no or minor degrees of brain injury after hypothermia.
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DOI：
10.1016/j.pediatrneurol.2014.01.013
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发表时间：
2014-05
影响因子：
3.8
通讯作者：
Chalak, Lina
中科院分区：
文献类型：
--
作者：
Rollins, Nancy;Booth, Timothy;Morriss, Michael C.;Sanchez, Pablo;Heyne, Roy;Chalak, Lina
MRI是围产期缺氧缺血性脑病幸存者主要神经发育障碍的替代生物标志物，因为基底节/丘脑损伤高度预测主要神经运动和认知问题。主要残疾和新生儿（R2-2）MRI的外观与治疗性低温改善。我们评估了常规MRI显示最小或无脑损伤时的神经发育结局。IRB批准的2005年至2011年因缺氧缺血性脑病接受冷却的62名婴儿（≥36周; ≥1800 g; 34名男性/28名女性）系列，这些婴儿在22 +/− 7（R2-9）月龄时接受了新生儿（R2-2）MRI和Bayley婴幼儿发育量表-III。第5-14天（平均8天）的MRI评分为正常（评分=0），仅显示局灶性灰质或白色物质损伤（评分=1），或基底节/丘脑和/或分水岭病变伴或不伴更广泛的半球损伤（评分=2）。确定MR评分0和1的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）以及MRI评分与MRI时年龄之间的统计学相互作用。在35/62例患者中观察到MR评分=0; 26/35例（74%）为典型进展，7例（20%）为中度，2例（6%）为重度延迟。在17/62例（27%）患者中观察到MR评分=1; 5/17例（29%）正常，11/17例（65%）中度发育迟缓，1/17例（6%）重度神经发育迟缓。MR评分为0和1的52例患者中，40%异常。正常MRI的NPV为74%。对于评分1，灵敏度为95% [CI 63%-83%]，特异性为84% [CI 70%-90%]，PPV为84% [CI 71%-93%]，NPV为74% [CI 62%-82%]。当详细说明HIE伴降温后儿童早期的神经发育状况时，需要谨慎，需要进行更长时间的随访研究，以确定新生儿MRI（R2-4）显示无脑损伤或轻度脑损伤的预后意义。
MRI is a surrogate biomarker for major neurodevelopmental disabilities in survivors of perinatal hypoxic-ischemic encephalopathy as injury to the basal ganglia/thalami is highly predictive of major neuromotor and cognitive problems. Major disabilities and the appearance of neonatal (R2-2) MRI are improved with therapeutic hypothermia. We evaluated neurodevelopmental outcomes when conventional MRI showed minimal or no brain injury. IRB-approved series of 62 infants (≥36 weeks; ≥1800 g; 34 male/28 female) cooled for hypoxic-ischemic encephalopathy from 2005-11 who underwent neonatal (R2-2) MRI and Bayley Scales of Infant and Toddler Development-III 22 +/− 7 (R2-9) months of age. MRI at 5–14 (mean 8) days was scored as normal (score=0), showing focal grey or white matter injury only (score =1), or basal ganglia/thalamic and/or watershed lesions with or without more extensive hemispheric injury (score =2). Sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) for MR scores 0 and 1 and statistical interaction between MRI score and age at MRI were determined. MR score=0 was seen in 35/62 patients; 26/35 (74%) were typically developing, 7 (20%) had moderate and 2 (6%) had severe delay. MR score=1 was seen in 17/62 (27%) patients; 5/17 (29%) were normal, 11/17 (65%) had moderate delay, and 1/17 (6%) had severe neurodevelopmental delay. Of the 52 patients with MR scores 0 and 1, 40% were abnormal. The NPV of a normal MRI was 74%. For score 1, sensitivity was 95% [CI 63%–83%], specificity 84% [CI 70%–90%], PPV 84% [CI 71%–93%], and NPV 74% [CI 62%–82%]. Caution is warranted when prognosticating about neurodevelopmental status in early childhood after HIE with cooling and longer follow-up studies are needed to determine the prognostic significance of a neonatal MRI (R2-4) showing no or minor degrees of brain injury.
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影响因子：
48
作者：
Rutherford, Mary;Ramenghi, Luca A.;Edwards, A. David;Brocklehurst, Peter;Halliday, Henry;Levene, Malcolm;Strohm, Brenda;Thoresen, Marianne;Whitelaw, Andrew;Azzopardi, Denis
通讯作者：
Azzopardi, Denis
DOI：
10.1056/nejmoa1112066
发表时间：
2012-05-31
期刊：
The New England journal of medicine
影响因子：
--
作者：
Shankaran S;Pappas A;McDonald SA;Vohr BR;Hintz SR;Yolton K;Gustafson KE;Leach TM;Green C;Bara R;Petrie Huitema CM;Ehrenkranz RA;Tyson JE;Das A;Hammond J;Peralta-Carcelen M;Evans PW;Heyne RJ;Wilson-Costello DE;Vaucher YE;Bauer CR;Dusick AM;Adams-Chapman I;Goldstein RF;Guillet R;Papile LA;Higgins RD;Eunice Kennedy Shriver NICHD Neonatal Research Network
通讯作者：
Eunice Kennedy Shriver NICHD Neonatal Research Network
影响因子：
168.9
作者：
Gluckman, PD;Wyatt, JS;Gunn, AJ
通讯作者：
Gunn, AJ
影响因子：
5.1
作者：
Miller, SP;Ramaswamy, V;Ferriero, DM
通讯作者：
Ferriero, DM
影响因子：
3.6
作者：
Li, Amanda M.;Chau, Vann;Miller, Steven P.
通讯作者：
Miller, Steven P.