Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal Hypoglycemia
Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal Hypoglycemia
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DOI：
10.1542/peds.2007-2822
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发表时间：
2008-07-01
期刊：
影响因子：
8
通讯作者：
Cowan, Frances M.
中科院分区：
文献类型：
--
作者：
Burns, Charlotte M.;Rutherford, Mary A.;Cowan, Frances M.
背景症状性新生儿低血糖可能与以后的神经发育障碍有关。早期MRI扫描确定的脑损伤模式及其与低血糖损伤性质和神经发育结果的关系尚不明确。我们研究了35例足月儿，在症状性新生儿低血糖（中位血糖水平：1 mmol/L）后进行早期脑MRI扫描，无缺氧缺血性脑病证据。围产期数据与229例足月、神经系统正常婴儿（对照组）的等效数据进行比较，以确定低血糖的危险因素。至少在18个月时评估神经发育结果。结果。白色异常发生在94%的低血糖婴儿中，43%为重度，29%的病例主要为后部模式。51%的婴儿出现皮质异常; 30%有白色出血，40%有基底节/丘脑病变，11%有内囊后肢异常。三个婴儿有大脑中动脉梗塞。23名婴儿（65%）在18个月时表现出损伤，这与白色物质损伤的严重程度和内囊后肢的受累有关。14名婴儿表现出生长受限，1名巨大儿，2名母亲患有糖尿病。妊娠高血压综合征、癫痫家族史、紧急剖宫产和复苏的需要在病例组中比对照组更常见。与症状性新生儿低血糖相关的损伤模式比以前描述的更多样化。白色损伤不局限于后部区域;观察到出血、大脑中动脉梗死和基底节/丘脑异常，皮质受累常见。早期MRI结果比低血糖的严重程度或持续时间对预测神经发育结局更有指导意义。
BACKGROUND. Symptomatic neonatal hypoglycemia may be associated with later neurodevelopmental impairment. Brain injury patterns identified on early MRI scans and their relationships to the nature of the hypoglycemic insult and neurodevelopmental outcomes are poorly defined.METHODS. We studied 35 term infants with early brain MRI scans after symptomatic neonatal hypoglycemia ( median glucose level: 1 mmol/L) without evidence of hypoxic-ischemic encephalopathy. Perinatal data were compared with equivalent data from 229 term, neurologically normal infants ( control subjects), to identify risk factors for hypoglycemia. Neurodevelopmental outcomes were assessed at a minimum of 18 months.RESULTS. White matter abnormalities occurred in 94% of infants with hypoglycemia, being severe in 43%, with a predominantly posterior pattern in 29% of cases. Cortical abnormalities occurred in 51% of infants; 30% had white matter hemorrhage, 40% basal ganglia/thalamic lesions, and 11% an abnormal posterior limb of the internal capsule. Three infants had middle cerebral artery territory infarctions. Twenty-three infants (65%) demonstrated impairments at 18 months, which were related to the severity of white matter injury and involvement of the posterior limb of the internal capsule. Fourteen infants demonstrated growth restriction, 1 had macrosomia, and 2 had mothers with diabetes mellitus. Pregnancy-induced hypertension, a family history of seizures, emergency cesarean section, and the need for resuscitation were more common among case subjects than control subjects.CONCLUSIONS. Patterns of injury associated with symptomatic neonatal hypoglycemia were more varied than described previously. White matter injury was not confined to the posterior regions; hemorrhage, middle cerebral artery infarction, and basal ganglia/ thalamic abnormalities were seen, and cortical involvement was common. Early MRI findings were more instructive than the severity or duration of hypoglycemia for predicting neurodevelopmental outcomes.