Diffusion tensor imaging in extremely low birth weight infants managed with hypercapnic vs. normocapnic ventilation.
Diffusion tensor imaging in extremely low birth weight infants managed with hypercapnic vs. normocapnic ventilation.
复制标题
采用高碳酸血症与正常碳酸血症通气治疗的极低出生体重婴儿的弥散张量成像。
DOI：
10.1007/s00247-014-2946-8
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发表时间：
2014-08
影响因子：
2.3
通讯作者：
Kaiser, Jeffrey R.
中科院分区：
文献类型：
--
作者：
Ou, Xiawei;Glasier, Charles M.;Ramakrishnaiah, Raghu H.;Angtuaco, Teresita L.;Mulkey, Sarah B.;Ding, Zhaohua;Kaiser, Jeffrey R.
关键词：
允许性高碳酸血症是一种用于预防通气极低出生体重（ELBW，出生体重≤1000 g）婴儿肺损伤的治疗策略。然而，有回顾性证据表明，高二氧化碳与脑损伤有关。本研究的目的是比较出生后第一周内随机接受高碳酸通气与正常碳酸通气的ELBW婴儿以及健康非通气足月新生儿在足月等效年龄时的脑白色物质发育。本研究纳入了来自随机对照试验的22名ELBW婴儿; 11名婴儿在出生后第一周内接受高碳酸血症（经皮PCO 2 [tcPCO 2] 50-60 mm Hg）通气，11名婴儿在出生后第一周内接受正常碳酸血症（tcPCO 2 35-45 mm Hg）通气，同时仍插管。另取10例足月健康新生儿作为对照组。在足月时对ELBW婴儿进行磁共振成像（MRI）和弥散张量成像（DTI），在对照婴儿约2周龄时进行。采用文献中的评分系统对ELBW和对照组婴儿常规MRI上的白色损伤进行分级。基于道的空间统计（TBSS）被用来评估的差异，在DTI测量分数各向异性（FA，空间归一化到一个定制的模板）之间的ELBW和足月对照婴儿。高碳酸血症和正常碳酸血症ELBW婴儿的常规MRI白色物质评分无差异（7.3 ± 1.7 vs. 6.9 ± 1.4，p=0.65）。TBSS分析未显示两个ELBW婴儿组之间的显著差异（p<0.05，校正），尽管在多重比较校正之前，与正常碳酸血症婴儿相比，高碳酸血症婴儿有许多FA较低的区域（p <0.05，未校正），没有FA较高的区域（p<0.05，未校正）。与对照组婴儿相比，正常碳酸血症的ELBW婴儿有几个FA显著较低的小区域，而高碳酸血症的ELBW婴儿有FA显著较低的更广泛区域（p<0.05，多重比较完全校正）。正常碳酸血症通气与允许性高碳酸血症可能与ELBW婴儿足月时白色发育改善相关。然而，这种影响很小，在常规MRI上不明显。需要使用更大的样本量进行进一步研究，以评估ELBW婴儿的允许性高碳酸血症通气是否与更差的白色发育相关。
Permissive hypercapnia is a ventilatory strategy used to prevent lung injury in ventilated extremely low birth weight (ELBW, birth weight ≤1000 g) infants. However, there is retrospective evidence showing that high CO2 is associated with brain injury. The objective of this study was to compare brain white matter development at term-equivalent age in ELBW infants randomized to hypercapnic vs. normocapnic ventilation during the first week of life and in healthy non-ventilated term newborns. Twenty-two ELBW infants from a randomized controlled trial were included in this study; 11 received hypercapnic (transcutaneous PCO2 [tcPCO2] 50–60 mm Hg) ventilation and 11 normocapnic (tcPCO2 35–45 mm Hg) ventilation during the first week of life while still intubated. In addition, 10 term healthy newborns served as controls. Magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) was performed at term-equivalent age for the ELBW infants and at approximately 2 weeks of age for the control infants. White matter injury on conventional MRI was graded in the ELBW and control infants using a scoring system adopted from literature. Tract-based spatial statistics (TBSS) was used to evaluate for differences in DTI measured fractional anisotropy (FA, spatially normalized to a customized template) among the ELBW and term control infants. Conventional MRI white matter scores were not different (7.3 ± 1.7 vs. 6.9 ± 1.4, p=0.65) between the hypercapnic and normocapnic ELBW infants. TBSS analysis did not show significant differences (p<0.05, corrected) between the two ELBW infant groups, although before multiple comparisons correction, hypercapnic infants had many regions with lower FA (p<0.05, uncorrected) and no regions with higher FA (p<0.05, uncorrected) compared to normocapnic infants. When compared to the control infants, normocapnic ELBW infants had a few small regions with significantly lower FA, while hypercapnic ELBW infants had more widespread regions with significantly lower FA (p<0.05, fully corrected for multiple comparisons). Normocapnic ventilation vs. permissive hypercapnia may be associated with improved white matter development at term-equivalent age in ELBW infants. This effect, however, was small and was not apparent on conventional MRI. Further research is needed using larger sample sizes to assess if permissive hypercapnic ventilation in ELBW infants is associated with worse white matter development.
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影响因子：
8
作者：
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通讯作者：
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