Defining the nature of the cerebral abnormalities in the premature infant: A qualitative magnetic resonance imaging study
Defining the nature of the cerebral abnormalities in the premature infant: A qualitative magnetic resonance imaging study
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DOI：
10.1067/s0022-3476(03)00357-3
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发表时间：
2003-08-01
影响因子：
5.1
通讯作者：
Volpe, JJ
中科院分区：
文献类型：
--
作者：
Inder, TE;Wells, SJ;Volpe, JJ
本研究的目的是在一项以极低出生体重婴儿为基础的纵向人群研究中定性地定义白质和灰质异常的性质和程度。围产期因素随后与磁共振成像（MRI）异常的存在和严重程度有关。方法从1998年11月至2000年12月，在征得父母同意后，连续招募100名早产儿（98%符合条件）在克赖斯特彻奇妇女医院新生儿重症监护病房接受足月MRI扫描。扫描结果由一名有儿科MRI经验的神经放射科医生进行分析，并使用白质（囊肿、信号异常、体积损失、脑室肿大、胼胝体变薄、髓鞘形成）类灰质（灰质信号异常、旋转、蛛网膜下腔）的综合标准对MRI进行第二次独立评分。结果根据单项得分以及中重度白质评分进行分析。总灰质评分，类总脑评分。结果平均胎龄27.9±2.4周（范围23 ~ 32周），平均出生体重1063±292 g。中重度白质异常的最大单因素预测因子为低胎龄（优势比[OR]， 1.3； 95%可信区间[CI]， 1.1-1.7; P < 0.01）、产妇发热（优势比[OR]， 2.2; 95% CI, 1.1-4.6; P < 0.04）、分娩时婴儿败血症（优势比[OR]， 1.8; 95% CI, 1.1-3.6; P = 0.03）。肌力支持（OR, 2.7; 95% CI, 1.5-4.5; P < 0.001）、动脉导管未闭（OR, 2.2; 95% CI, 1.2-3.8; P = 0.01）、III/IV级脑室内出血（P = 0.015）和气胸的发生（P = 0.05）。宫内生长限制有显著的保护作用（OR, 0.51; 95% CI, 0.23-0.99, P = 0.04）。灰质异常与白质异常的存在及严重程度高度相关。一种独特的脑异常模式，包括明显的弥漫性白质萎缩，脑室肿大，脑回发育不成熟。11例初产妊娠患儿中有10例蛛网膜下腔增大
Objectives The aim of this study was to define qualitatively the nature kind extent of white and gray matter abnormalities in a longitudinal population-based study of infants with very low birth weight. Perinatal factors were then related to the presence and severity of magnetic resonance imaging (MRI) abnormalities.Methods From November 1998 to December 2000, 100 consecutive premature infants admitted to the neonatal intensive care unit at Christchurch Women's Hospital were recruited (98% eligible) after informed parental consent to undergo ail MRI scan at term equivalent. The scans were analyzed by a single neuroradiologist experienced in pediatric MRI, with a second independent scoring of the MRI using a combination of criteria for white matter (cysts, signal abnormality, loss of volume, ventriculomegaly, corpus callosal thinning, myelination) kind gray matter (gray matter signal abnormality, gyration, subarachnoid space). Results were analyzed against individual item scores as well as the presence of moderate-severe white matter score. total gray matter score, kind total brain score.Results The mean gestational age was 27.9 +/- 2.4 weeks (range, 23-32 weeks), and mean birth weight was 1063 +/- 292 g. The greatest univariate predictors for moderate-severe white matter abnormality were lower gestational age (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.7; P < .01), maternal fever (OR, 2.2; 95% CI, 1.1-4.6; P < .04), proven sepsis in the infant at delivery (OR, 1.8; 95% CI, 1.1-3.6; P = 0.03). inotropic support (OR, 2.7; 95% CI, 1.5-4.5; P < .001), patent ductus arteriosus (OR, 2.2; 95% CI, 1.2-3.8; P = .01), grade III/IV intraventricular hemorrhage (P = .015), and the occurrence of a pneumothorax (P = .05). There was a significant protective effect of intrauterine growth restriction (OR, 0.51; 95% CI, 0.23-0.99, P = .04). Gray matter abnormality was highly related to the presence and severity of white matter abnormality. A unique pattern of cerebral abnormality consisting of significant diffuse white matter atrophy, ventriculomegaly, immature gyral development. and enlarged subarachnoid space was found in 10 of 11 infants with birth gestation