Possible antenatal and perinatal related factors in development of cystic periventricular leukomalacia
Possible antenatal and perinatal related factors in development of cystic periventricular leukomalacia
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DOI：
10.1016/j.braindev.2004.02.011
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发表时间：
2005-01-01
影响因子：
1.7
通讯作者：
Mizutani, S
中科院分区：
文献类型：
--
作者：
Murata, Y;Itakura, A;Mizutani, S
囊性脑室周围白质软化症（cysticperiventricularleukomalacia，cPVL）是早产儿的主要缺血性脑损伤，其特征是脑室周围区域的白色物质坏死和脑瘫或癫痫的痉挛性运动缺陷的主要神经病理学改变。最近的报道强烈表明，与cPVL相关的脑损伤可能已经在子宫内发生。在这项研究中，我们回顾性地检索了与cPVL相关的可能临床情况，以便于评估最佳管理。1992-1997年，共收集201例胎龄24 ~ 33周的新生儿，回顾性分析了18项与cPVL有关的因素。至少在矫正年龄18个月之前检查精神发育。201例早产儿中35例诊断为cPVL，后来发生痉挛性双瘫。有23例先兆子痫病例，无婴儿患有cPVL。在单因素分析中，产前暴露于吲哚美辛、脐带长度大于或等于40 cm和Apgar评分低与cPVL发生风险增加2-3显著相关。而产前硫酸镁可降低风险。绒毛膜炎与危险性呈正相关，但未达到统计学意义。在多变量分析中，我们发现，产前暴露于吲哚美辛，低Apgar评分的统计学意义。和产前硫酸镁我们的研究结果表明，先兆子痫和产前接触硫酸镁降低了cPVL的风险，而产前接触吲哚美辛和低Apgar评分与cPVL的发生有关。这些发现支持了越来越多的共识，即cPVL通常是母体和胎儿因素以及产前治疗的结果。(C)2004 Elsevier B. V.保留所有权利。
Cystic periventricular leukomalacia (cPVL), the principal ischemic brain injury in premature infants, is characterized by necrosis of the white matter in the periventricular region and the major neuropathology for spastic motor deficits in cerebral palsy or epilepsy. Recent reports strongly suggest that the brain injury associated with cPVL may have already occurred in utero. In this study we searched retrospectively for possible clinical situations related to cPVL to facilitate assessment of optimal management. A total of 201 babies born at gestational ages from 24 to 33 weeks were entered into the study (1992-1997) and examined for involvement of 18 factors in cPVL retrospectively. And psychomotor development was examined at least until 18 months of corrected age. Among 201 premature babies 35 cases were diagnosed as cPVL later developed spastic diplegia. There are 23 cases of preeclampsia, no infant suffering from cPVL. In the univariate analysis, exposure to antenatal indomethacin, cord length greater than or equal to40 cm, and a low Apgar score were significantly associated with a 2-3 risk increased of cPVL occurrence. while antenatal magnesium sulfate reduced the risk. Chorioamnionitis was positively correlated with the risk, but did not reach statistical significance. In the multivariate analysis we found the statistical significance in exposure to antenatal indomethacin, a low Apgar score. and antenatal magnesium sulfate. Our results suggested that preeclampsia and antenatal exposure of magnesium sulfate reduced the risk while antenatal exposure of indomethacin and low Apgar score associated with the occurrence of cPVL. These findings support a growing consensus that cPVL is often the result of maternal and fetal factors as well as antenatal treatment. (C) 2004 Elsevier B.V. All rights reserved.