Abnormal cerebral structure is present at term in premature infants
Abnormal cerebral structure is present at term in premature infants
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DOI：
10.1542/peds.2004-0326
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发表时间：
2005-02-01
期刊：
影响因子：
8
通讯作者：
Volpe, JJ
中科院分区：
文献类型：
--
作者：
Inder, TE;Warfield, SK;Volpe, JJ
背景对早产儿结局的长期研究清楚地证明，大多数早产儿有明显的运动、认知和行为缺陷。然而，对这些不良神经学结局背后的大脑异常的性质的理解有限。本研究的总体目的是通过使用先进的三维磁共振成像（MRI）技术，在一项极低出生体重早产儿与足月出生婴儿相比的大型纵向队列研究中，定量定义足月等效脑组织体积的变化。我们的目的还在于确定任何围产期病变的关系，如白色物质（WM）损伤或其他潜在的不利因素的定量结构的改变。此外，我们希望确定的结构变化的关系，短期神经发育的结果。从1998年11月至2000年12月，119名连续早产儿入院的新生儿重症监护病房在基督城妇女医院（基督城，新西兰）和皇家妇女医院（墨尔本，澳大利亚）被招募（88%的合格）后，知情的父母同意接受MRI扫描在相当的期限。还招募了两个研究中心的21名足月出生婴儿。采集后进行先进的三维组织分割和三维重建，以估计脑组织的体积：灰质（GM;皮质和深核结构），WM（有髓和无髓），和脑脊液（CSF）。与足月出生的婴儿相比，早产儿在足月时表现出大脑皮质GM体积的显著减少（早产儿[平均值+/- SD]：178 +/- 41 mL;足月儿：227 +/- 26 mL）和深层核GM体积（早产儿：10.8 ± 4.1 mL;足月儿：13.8 ± 5.2 mL）和CSF体积增加（早产儿：45.6 ± 22.1 mL;足月儿：28.9 ± 16 mL）。脑体积改变的主要预测因素是出生时的胎龄和脑WM损伤的存在。皮质GM和深层核GM体积显著减少和CSF体积增加的婴儿在1岁时表现出中度至重度的神经发育障碍。这项对早产儿的MRI研究进一步定义了早在足月时就存在的定量脑结构异常的性质。异常特别涉及大脑神经元区域，包括皮质和深核结构。大脑改变的模式与出生时的不成熟程度和伴随的WM损伤最显着相关。这些改变之后是异常的短期神经发育结果。
Background. Long-term studies of the outcome of very prematurely born infants have clearly documented that the majority of such infants have significant motor, cognitive, and behavioral deficits. However, there is a limited understanding of the nature of the cerebral abnormality underlying these adverse neurologic outcomes.Aim. The overall aim of this study was to define quantitatively the alterations in cerebral tissue volumes at term equivalent in a large longitudinal cohort study of very low birth weight premature infants in comparison to term-born infants by using advanced volumetric 3-dimensional magnetic resonance imaging (MRI) techniques. We also aimed to define any relationship of such perinatal lesions as white matter (WM) injury or other potentially adverse factors to the quantitative structural alterations. Additionally, we wished to identify the relationship of the structural alterations to short-term neurodevelopmental outcome.Methods. From November 1998 to December 2000, 119 consecutive premature infants admitted to the neonatal intensive care units at Christchurch Women's Hospital ( Christchurch, New Zealand) and the Royal Women's Hospital ( Melbourne, Australia) were recruited (88% of eligible) after informed parental consent to undergo an MRI scan at term equivalent. Twenty-one term-born infants across both sites were recruited also. Postacquisition advanced 3-dimensional tissue segmentation with 3-dimensional reconstruction was undertaken to estimate volumes of cerebral tissues: gray matter ( GM; cortical and deep nuclear structures), WM ( myelinated and unmyelinated), and cerebrospinal fluid (CSF).Results. In comparison to the term-born infants, the premature infants at term demonstrated prominent reductions in cerebral cortical GM volume ( premature infants [ mean +/- SD]: 178 +/- 41 mL; term infants: 227 +/- 26 mL) and in deep nuclear GM volume ( premature infants: 10.8 +/- 4.1 mL; term infants: 13.8 +/- 5.2 mL) and an increase in CSF volume ( premature infants: 45.6 +/- 22.1 mL; term infants: 28.9 +/- 16 mL). The major predictors of altered cerebral volumes were gestational age at birth and the presence of cerebral WM injury. Infants with significantly reduced cortical GM and deep nuclear GM volumes and increased CSF volume volumes exhibited moderate to severe neurodevelopmental disability at 1 year of age.Conclusions. This MRI study of prematurely born infants further defines the nature of quantitative cerebral structural abnormalities present as early as term equivalent. The abnormalities particularly involve cerebral neuronal regions including both cortex and deep nuclear structures. The pattern of cerebral alterations is related most significantly to the degree of immaturity at birth and to concomitant WM injury. The alterations are followed by abnormal short-term neurodevelopmental outcome.