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

当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%至15%会出现神经系统并发症，80%的脑瘫被认为是PVL的结果。根据全日本的监测分析，PVL的发病率多年来没有变化。ECHO二次谐波成像技术具有操作简单、床边操作方便、对细毛细血管血流检测灵敏等优点，目前正尝试广泛应用于新生儿临床。该技术已应用于肝、心血流检测及成人神经病学领域。我们已经成功地检测血流在所有情况下执行这种二次谐波成像技术。与MRI和CT相比，检查时间极短。在床边进行是足够安全的，不需要移动病人，也不需要给病人注射镇静剂。PVL患者伴晚发性心功能障碍（LCD）发作，MRI显示有严重的神经系统预后。在脓毒症中，氧化应激与炎症或抗炎细胞因子密切相关。

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.