Neonatal MRI to predict neurodevelopmental outcomes in preterm infants
Neonatal MRI to predict neurodevelopmental outcomes in preterm infants
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DOI：
10.1056/nejmoa053792
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发表时间：
2006-08-17
影响因子：
158.5
通讯作者：
Inder, Terrie E.
中科院分区：
文献类型：
--
作者：
Woodward, Lianne J.;Anderson, Peter J.;Inder, Terrie E.
背景：早产儿是神经发育不良结局的高危人群。方法：我们研究了167名极早产儿(出生时，胎龄不超过30周)，以评估足月儿(胎龄40周)MRI定性定义的白质和灰质异常与2岁时严重认知障碍、严重精神运动障碍、脑性瘫痪和神经感觉(听力或视觉)损害(校正早产儿)的风险之间的关系。结果：两岁时，17%的婴儿有严重的认知障碍，10%的婴儿有严重的精神运动障碍，10%的婴儿有脑性瘫痪，11%的人有神经感觉障碍。在足月出生的婴儿中，21%的婴儿出现中重度脑白质异常，预示着两岁时会出现以下不良后果：认知延迟(优势比3.6；95%可信区间1.5至8.7)、运动延迟(优势比10.3；95%可信区间3.5至30.8)、脑性瘫痪(优势比9.6；95%可信区间3.2至28.3)以及神经感觉障碍(优势比4.2；95%可信区间1.6至11.3)。灰质异常(出现在49%的婴儿中)也与认知延迟、运动延迟和脑性瘫痪有关，但相关性较小。MRI上中到重度的脑白质异常是严重运动迟缓和脑性瘫痪的重要预测因素，在新生儿期调整其他指标后，包括头颅超声检查结果。结论：极早产儿在足月时MRI异常发现强烈预测两岁时神经发育不良的结局。这些发现表明，在这些婴儿的风险分层中，等值足月MRI可以发挥作用。
BACKGROUND:Very preterm infants are at high risk for adverse neurodevelopmental outcomes. Magnetic resonance imaging (MRI) has been proposed as a means of predicting neurodevelopmental outcomes in this population.METHODS:We studied 167 very preterm infants (gestational age at birth, 30 weeks or less) to assess the associations between qualitatively defined white-matter and gray-matter abnormalities on MRI at term equivalent (gestational age of 40 weeks) and the risks of severe cognitive delay, severe psychomotor delay, cerebral palsy, and neurosensory (hearing or visual) impairment at 2 years of age (corrected for prematurity).RESULTS:At two years of age, 17 percent of infants had severe cognitive delay, 10 percent had severe psychomotor delay, 10 percent had cerebral palsy, and 11 percent had neurosensory impairment. Moderate-to-severe cerebral white-matter abnormalities present in 21 percent of infants at term equivalent were predictive of the following adverse outcomes at two years of age: cognitive delay (odds ratio, 3.6; 95 percent confidence interval, 1.5 to 8.7), motor delay (odds ratio, 10.3; 95 percent confidence interval, 3.5 to 30.8), cerebral palsy (odds ratio, 9.6; 95 percent confidence interval, 3.2 to 28.3), and neurosensory impairment (odds ratio, 4.2; 95 percent confidence interval, 1.6 to 11.3). Gray-matter abnormalities (present in 49 percent of infants) were also associated, but less strongly, with cognitive delay, motor delay, and cerebral palsy. Moderate-to-severe white-matter abnormalities on MRI were significant predictors of severe motor delay and cerebral palsy after adjustment for other measures during the neonatal period, including findings on cranial ultrasonography.CONCLUSIONS:Abnormal findings on MRI at term equivalent in very preterm infants strongly predict adverse neurodevelopmental outcomes at two years of age. These findings suggest a role for MRI at term equivalent in risk stratification for these infants.