Intestinal ultrasonography in infants with moderate or severe hypoxic-ischemic encephalopathy receiving hypothermia
Intestinal ultrasonography in infants with moderate or severe hypoxic-ischemic encephalopathy receiving hypothermia
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DOI：
10.1007/s00247-015-3447-0
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发表时间：
2016-01-01
影响因子：
2.3
通讯作者：
Sant'Anna, Guilherme M.
中科院分区：
文献类型：
--
作者：
Faingold, Ricardo;Cassia, Guilherme;Sant'Anna, Guilherme M.
患有缺氧缺血性脑病（HIE）的婴儿可能会出现多器官功能障碍，但对肠道受累的评估并不精确，并且基于几天后可能出现的非特异性临床症状。超声成像被认为是评估许多胃肠道疾病肠道受累情况的有用工具。描述接受低温治疗的婴儿的腹部超声检查结果，并调查其与缺氧缺血性损伤和死亡严重程度的关系。在出生后 36 小时内进行研究，以评估肠道外观（正常肠道、肠壁回声和厚度以及脱落的粘膜）、游离液体、蠕动和壁内灌注。这些发现在患有中度和重度脑病的婴儿之间进行了比较。超声检查结果也分为三个主要组，并与缺氧缺血性损伤严重程度标志物和死亡率进行比较。对入院时 19 名中度 HIE 婴儿和 9 名重度 HIE 婴儿进行了研究（出生时 17.7 +/- 9.5 小时）。主要超声检查结果为肠壁回声增强（78%）、游离液体（75%）、蠕动减少或消失（50%）以及肠粘膜脱落（21%）。异常的肠道发现，例如所有象限的肠壁回声增强和粘膜脱落，与更严重的缺氧缺血性损伤相关。所有12名肠道外观正常或仅限于一个象限的肠壁回声增强的患者均存活下来，而所有四个象限肠壁回声增强的患者中有7/15（47%）在住院期间死亡。粘膜脱落与死亡率增加相关（P < 0.001）。在接受低温治疗的婴儿中，通过超声检查评估发现肠道受累的发生率很高。观察到肠道检查结果与缺氧缺血性损伤的严重程度之间存在关联。脱落粘膜的存在是严重程度的潜在超声标志。
Infants with hypoxic-ischemic encephalopathy (HIE) may develop multiorgan dysfunction, but assessment of intestinal involvement is imprecise and based on nonspecific clinical signs that may occur several days later. Ultrasound imaging has been described as a helpful tool in assessing intestinal involvement in many gastrointestinal disorders.Describe abdominal ultrasonography findings in infants receiving therapeutic hypothermia and investigate its association with the severity of the hypoxic-ischemic insult and death.Studies were performed within the first 36 h of life to assess intestinal appearance (normal bowel, bowel wall echogenicity and thickness, and sloughed mucosa), free fluid, peristalsis and intramural perfusion. These findings were compared between infants with moderate and severe encephalopathy. Ultrasound findings were also categorized in three major groups and compared with markers of severity of the hypoxic-ischemic insult and with mortality.Nineteen infants with moderate and 9 with severe HIE at admission were studied (17.7 +/- 9.5 h of life). Major ultrasonography findings were increased bowel wall echogenicity (78%), free fluid (75%), decreased or absent peristalsis (50%) and sloughing of the intestinal mucosa (21%). Abnormal intestinal findings such as increased bowel wall echogenicity in all quadrants and presence of sloughed mucosa were associated with more severe hypoxic-ischemic insult. All 12 patients with normal bowel appearance or increased bowel wall echogenicity restricted to only one quadrant survived, whereas 7/15 (47%) patients with increased bowel wall echogenicity in all four quadrants died during hospitalization. The presence of sloughed mucosa was associated with increased mortality (P < 0.001).In infants receiving therapeutic hypothermia, a high prevalence of intestinal involvement was noted by using ultrasonographic assessment. An association between intestinal findings and severity of hypoxic-ischemic insult was observed. The presence of sloughed mucosa is a potential ultrasonographic sign of severity.