Intracranial hemorrhage in full-term newborns: a hospital-based cohort study.
Intracranial hemorrhage in full-term newborns: a hospital-based cohort study.
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DOI：
10.1007/s00234-010-0698-1
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发表时间：
2010-06
期刊：
影响因子：
2.8
通讯作者：
de Vries, Linda S.
中科院分区：
文献类型：
--
作者：
Brouwer, Annemieke J.;Groenendaal, Floris;Koopman, Corine;Nievelstein, Rutger-Jan A.;Han, Sen K.;de Vries, Linda S.
近年来，由于神经影像技术的改进，足月新生儿脑实质受累的颅内出血(ICH)的诊断更为常见。这项研究的目的是描述新生儿期的临床和神经影像数据，并将影像结果与住进3级新生儿重症监护病房(NICU)的医院人群的预后联系起来。从我们的神经影像数据库中，我们回顾检索了53名足月儿(1991-2008年)的记录和影像，在这些婴儿中，影像诊断为脑出血合并脑实质受累。记录临床资料，包括分娩方式、临床表现、神经症状、出血范围和部位、神经外科干预措施和神经发育结果。53例足月新生儿中，17例为幕下脑出血，20例为幕上脑出血，16例为两者兼有。惊厥是最常见的临床表现(71.7%)，另有10例(18.9%)出现窒息发作，5例无临床体征，但因围产期窒息(n = 2)、呼吸窘迫(n = 2)和出血后脑室扩张(n = 1)而住进新生儿重症监护室。所有婴儿均进行连续幅度积分脑电记录。48/53(90.6%)婴儿出现临床或亚临床癫痫发作，均接受了抗癫痫药物治疗。53名婴儿中有13名(24.5%)死亡。幕上脑出血的婴儿死亡率最低(10%)。3名中线移位的婴儿需要开颅手术，6名婴儿因流出道梗阻需要皮下储液罐，3名婴儿随后需要脑室-腹膜分流术。预后较差的组(死亡或发育商(DQ)和85)的5分钟阿普加评分显著较低(p = .006)。有37/40名年龄至少15个月的幸存者获得了随访数据。患者接受Griffiths智力发育量表评估，所有幸存者的平均DQ为97(SD = 12)。6名婴儿(17%)的DQ低于85[其中2名患有脑性瘫痪(CP)]。发生脑性瘫痪3例(8.6%)，小脑性共济失调1例，偏瘫2例。脑实质受累的脑出血有不良神经后遗症的风险，死亡率为24.5%，脑性瘫痪的发生率为8.6%。病死率高的部分原因是围产期窒息。与幕下脑出血和幕上脑出血合并脑出血的婴儿相比，幕上脑出血婴儿的死亡率较低，但并不显著。尽管通常有较大的实质内损害，但在34名无CP的幸存者中，有30人(88.2%)在15个月时神经发育结果正常。
In recent years, intracranial hemorrhage (ICH) with parenchymal involvement has been diagnosed more often in full-term neonates due to improved neuroimaging techniques. The aim of this study is to describe clinical and neuroimaging data in the neonatal period and relate imaging findings to outcome in a hospital-based population admitted to a level 3 neonatal intensive care unit (NICU). From our neuroimaging database, we retrospectively retrieved records and images of 53 term infants (1991–2008) in whom an imaging diagnosis of ICH with parenchymal involvement was made. Clinical data, including mode of delivery, clinical manifestations, neurological symptoms, extent and site of hemorrhage, neurosurgical intervention, and neurodevelopmental outcomes, were recorded. Seventeen of the 53 term infants had infratentorial ICH, 20 had supratentorial ICH, and 16 had a combination of the two. Seizures were the most common presenting symptom (71.7%), another ten infants (18.9%) presented with apneic seizures, and five infants had no clinical signs but were admitted to our NICU because of perinatal asphyxia (n = 2), respiratory distress (n = 2), and development of posthemorrhagic ventricular dilatation (n = 1). Continuous amplitude-integrated electroencephalography recordings were performed in all infants. Clinical or subclinical seizures were seen in 48/53 (90.6%) infants; all received anti-epileptic drugs. Thirteen of all 53 (24.5%) infants died. The lowest mortality rate was seen in infants with supratentorial ICH (10%). Three infants with a midline shift required craniotomy, six infants needed a subcutaneous reservoir due to outflow obstruction, and three subsequently required a ventriculoperitoneal shunt. The group with poor outcome (death or developmental quotient (DQ) <85) had a significantly lower 5-min Apgar score (p = .006). Follow-up data were available for 37/40 survivors aged at least 15 months. Patients were assessed with the Griffiths Mental Developmental Scales, and the mean DQ of all survivors was 97 (SD = 12). Six infants (17%) had a DQ below 85 [two of them had cerebral palsy (CP)]. Three infants developed CP (8.6%); one had cerebellar ataxia, and two had hemiplegia. ICH with parenchymal involvement carries a risk of adverse neurological sequelae with a mortality of 24.5% and development of CP in 8.6%. The high mortality rate could partly be explained by associated perinatal asphyxia. Infants with supratentorial ICH had a lower, although not significant, mortality rate compared with infants with infratentorial ICH and infants with a combination of supratentorial ICH and infratentorial ICH. In spite of often large intraparenchymal lesions, 30 of the 34 survivors without CP (88.2%) had normal neurodevelopmental outcome at 15 months.
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影响因子：
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