Research on the diagnosis of Periventricular Leukomalacia (PVL) by ECHO second harmonic imaging in preterm infants

目前新生儿医学最重要的问题是预防神经系统并发症，特别是脑瘫，智力低下和学习障碍。然而，众所周知，在妊娠32周以下出生的早产儿中有5 - 15%发生神经系统并发症，80%的脑瘫被认为是PVL的结果。根据日本全国的监测分析，PVL在日本的发病率多年来没有变化，我们目前正在尝试在新生儿临床中广泛使用的ECHO二次谐波成像技术具有操作简单、床旁操作、对检测细小毛细血管血流敏感等优点。该技术已应用于肝脏和心脏的血流检测以及成人神经学领域的应用，我们成功地对所有病例进行了二次谐波成像血流检测。与MRI和CT相比，检查时间极短。在床旁进行是足够安全的，不需要移动患者，也不需要给患者镇静剂。PVL伴LCD（晚发性心功能不全）发作的患者从MRI结果来看神经系统结局更好。在脓毒症中，氧化应激与炎症或抗炎细胞因子之间存在密切的相关性。

Most important issue in current neonatal medicine is the prevention of neurological complication especially cerebral palsy, mental retardation and learning disorders. However, it is well known that 5 to 15 % of preterm infants born under 32 weeks of gestation develop neurological complication and 80 % of cerebral palsy is recognized as the result of PVL. According to the surveillance analysis all over the Japan, the incidence of PVL does not change for many years in this country.Second harmonics imaging technique by ECHO which we are presently trying to widely use in the neonatal clinical is simple, bed-side operating, and sensitive for the detection of fine capillary blood flow. This technique has been used in liver and heart blood flow detection together with the usage in adult neurology field.We have succeeded in the detection of blood flow in all cased performed by this Second harmonic imaging technique. Examination time was extremely short compared to MRI and CT. It was safe enough to perform it at the bed side and did not require to move the patient nor to give the sedatives to the patient.PVL patient with LCD (Late onset cardiac dysfunction) episode had severer neurological outcome from the MRI findings. In sepsis, there is a close correlation between oxidative stress and inflammatory or anti-inflammatorycytokines.