Head growth in preterm infants: Correlation with magnetic resonance imaging and neurodevelopmental outcome
Head growth in preterm infants: Correlation with magnetic resonance imaging and neurodevelopmental outcome
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DOI：
10.1542/peds.2007-2671
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发表时间：
2008-06-01
期刊：
影响因子：
8
通讯作者：
Doyle, Lex W.
中科院分区：
文献类型：
--
作者：
Cheong, Jeanie L. Y.;Hunt, Rod W.;Doyle, Lex W.
目的。极早产与不良神经发育后遗症相关。头围一直被用作衡量脑生长的指标。有关头围与磁共振成像（MRI）的数据有限。本研究的目的是确定相当于足月年龄时头围与脑部MRI之间的关系，并将头围与2岁时的神经发育结果相关联。
患者与方法。招募了227名早产儿（出生体重<1250克或孕周<30周）。在出生时、足月时以及矫正年龄2岁时测量头围，并计算z分数。小头畸形定义为年龄和性别对应的头围z分数小于 -2个标准差。对足月时（n = 214）的MRI扫描进行白质和灰质异常分级，并计算不同组织类型的分割体积。矫正年龄2岁时（n = 202）的结果包括贝利婴儿发育量表II的评分。
结果。小头畸形从足月时的7.5%增加到2岁时的29.7%。头围与MRI上的白质或灰质异常之间没有显著关系。足月时头围与脑体积之间有很强的相关性。在足月时，与头围正常的婴儿相比，小头畸形婴儿的全脑组织体积和大多数分割体积显著减少，但在校正颅内总体积后，只有深部核团灰质体积仍然显著较低。在2岁时，小头畸形与较差的认知和运动发育以及脑瘫发生率增加有关。
结论。脑体积是足月时头围大小的一个决定因素。小头畸形与脑组织体积减少有关，尤其是深部核团灰质，这表明存在选择性易损性。早产儿出生后头围生长不良在2岁时变得更加明显，并且与不良神经发育结果和脑瘫密切相关。
OBJECTIVE. Extremely preterm birth is associated with adverse neurodevelopmental sequelae. Head circumference has been used as a measure of brain growth. There are limited data relating head circumference to MRI. The purpose of this work was to establish the relationship between head circumference with brain MRI at term-equivalent age and to relate head circumference with neurodevelopmental outcome at 2 years.PATIENTS AND METHODS. Two hundred and twenty-seven preterm infants (birth weight of < 1250 g or < 30 weeks' gestation) were recruited. Head circumference was measured at birth, term, and 2 years' corrected age, and z scores were computed. Microcephaly was defined as a head circumference z score of less than -2 SDs for age and gender. MRI scans at term (n = 214) were graded for white and gray matter abnormalities, and segmented volumes were calculated for different tissue types. Outcome at 2 years' corrected age (n = 202) included scores on the Bayley Scales of Infant Development II.RESULTS. Microcephaly increased from 7.5% at term to 29.7% at 2 years. There was no significant relationship between head circumference and white or gray matter abnormalities on MRI. There was a strong correlation between head circumference and brain volume at term. At term, microcephalic infants had significantly decreased volumes for total brain tissue and most segmented volumes compared with infants with normal head circumference, but only deep nuclear gray matter volume remained significantly lower when adjusted for total intracranial volume. At 2 years, microcephaly was associated with poorer cognitive and motor development and an increased rate of cerebral palsy.CONCLUSIONS. Brain volume is a determinant of head size at term. Microcephaly is associated with a reduction of brain tissue volumes, especially deep nuclear gray matter, which suggests a selective vulnerability. Poor postnatal head growth in preterm infants becomes more evident by 2 years and is strongly associated with poor neurodevelopmental outcome and cerebral palsy.