Effect of Chorioamnionitis on Brain Development and Injury in Premature Newborns
Effect of Chorioamnionitis on Brain Development and Injury in Premature Newborns
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DOI：
10.1002/ana.21713
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发表时间：
2009-08-01
影响因子：
11.2
通讯作者：
Miller, Steven P.
中科院分区：
文献类型：
--
作者：
Chau, Vann;Poskitt, Kenneth J.;Miller, Steven P.
目的：绒毛膜羊膜炎与非囊性白质损伤（一种早产儿常见的脑损伤）之间的关系仍存在争议。我们的目的是确定绒毛膜羊膜炎和产后危险因素与白质损伤的关系，以及绒毛膜羊膜炎对早期大脑发育的影响，采用先进的磁共振成像技术。方法：92例早产新生儿（24 ~ 32孕周），中位孕龄31.9周，中位孕龄40.3周。使用经过验证的系统对组织病理学羊膜炎和白质损伤进行评分。脑代谢（n -乙酰天冬氨酸/胆碱和乳酸/胆碱）的磁共振波谱测量和微结构（平均扩散率和分数各向异性）的扩散张量成像从预定义的大脑区域计算。结果：新生儿发生组织病理学绒毛膜羊膜炎31例（34%），白质损伤26例（28%）。组织病理学绒毛膜羊膜炎与白质损伤风险增加无关（相对风险：1.2;p = 0.6）。出生后感染和低血压需要治疗的新生儿白质损伤的风险较高（p < 0.03）。调整扫描和感兴趣区域的胎龄，组织病理学绒毛膜羊膜炎对脑代谢和微观结构发育没有显著影响（p >.1）。相比之下，白质损伤与n -乙酰天冬氨酸/胆碱降低（-8.9%,p = 0.009）和白质分数各向异性降低（-11.9%,p = 0.01）相关。解释：组织病理学绒毛膜羊膜炎似乎与磁共振成像白质损伤风险增加或大脑发育异常无关。相反，出生后感染和低血压与早产儿白质损伤的风险增加有关。
Objective: The association of chorioamnionitis and noncystic white matter injury, a common brain injury in premature newborns, remains controversial. Our objectives were to determine the association of chorioamnionitis and postnatal risk factors with white matter injury, and the effects of chorioamnionitis on early brain development, using advanced magnetic resonance imaging.Methods: Ninety-two preterm newborns (24-32 weeks gestation) were studied at a median age of 31.9 weeks and again at 40.3 weeks gestation. Histopathological chorioamnionitis and white matter injury were scored using validated systems. Measures of brain metabolism (N-acerylaspartate/choline and lactate/choline) on magnetic resonance spectroscopy, and microstructure (average diffusivity and fractional anisotropy) on diffusion tensor imaging were calculated from predefined brain regions.Results: Thirty-one (34%) newborns were exposed to histopathological chorioamnionitis, and 26 (28%) had white matter injury. Histopathological chorioamnionitis was not associated with an increased risk of white matter injury (relative risk: 1.2; p = 0.6). Newborns with postnatal infections and hypotension requiring therapy were at higher risk of white matter injury (p < 0.03). Adjusting for gestational age at scan and regions of interest, histopathological chorioamnionitis did not significantly affect brain metabolic and microstructural development (p > 0.1). In contrast, white matter injury was associated with lower N-acetylaspartate/choline (-8.9%; p = 0.009) and lower white matter fractional anisotropy (-11.9%; p = 0.01).Interpretation: Histopathological chorioamnionitis does not appear to be associated with an increased risk of white matter injury on magnetic resonance imaging or with abnormalities of brain development. In contrast, postnatal infections and hypotension are associated with an increased risk of white matter injury in the premature newborn.