Mercuri E, Ricci D, Cowan F M, Lessing D, Frisone M F, Haataja L, Counsell S J, Dubowitz L M, Rutherford M A
Department of, Imperial College of Science, Technology and Medicine, Hammersmith Campus, London, United Kingdom.
Pediatrics. 2000 Aug;106(2 Pt 1):235-43. doi: 10.1542/peds.106.2.235.
The aims of the study were to establish the relationship between head growth in the first year of life with the pattern on injury on neonatal magnetic resonance imaging (MRI) in infants with hypoxic-ischemic encephalopathy (HIE) and to relate these to the neurodevelopmental outcome.
Fifty-two term infants who presented at birth with a neonatal encephalopathy consistent with HIE and who had neonatal brain MRI were entered into the study. Head circumference charts were evaluated retrospectively and the head growth over the first year of life compared with the pattern of brain lesions on MRI and with the neurodevelopmental outcome at 1 year of age. Suboptimal head growth was classified as a drop of >2 standard deviations across the percentiles with or without the development of microcephaly, which was classified as a head circumference below the third percentile.
There was no statistical difference between the neonatal head circumferences of the infants presenting with HIE and control infants. At 12 months, microcephaly was present in 48% of the infants with HIE, compared with 3% of the controls. Suboptimal head growth was documented in 53% of the infants with HIE, compared with 3% of the controls. Suboptimal head growth was significantly associated with the pattern of brain lesions, in particular to involvement of severe white matter and to severe basal ganglia and thalamic lesions. Suboptimal head growth predicted abnormal neurodevelopmental outcome with a sensitivity of 79% and a specificity of 78%, compared with the presence of microcephaly at 1 year of age, which had a sensitivity of only 65% and a specificity of 73%. The exceptions were explained by infants with only moderate white matter abnormalities who had suboptimal head growth but normal outcome at 1 year of age and by infants with moderate basal ganglia and thalamic lesions only who had normal head growth but significant motor abnormality.
本研究旨在确定缺氧缺血性脑病（HIE）婴儿出生后第一年头部生长与新生儿磁共振成像（MRI）损伤模式之间的关系，并将这些与神经发育结局相关联。
52名足月出生时患有与HIE一致的新生儿脑病且进行了新生儿脑MRI检查的婴儿纳入研究。回顾性评估头围图表，并将出生后第一年的头部生长情况与MRI上的脑损伤模式以及1岁时的神经发育结局进行比较。头围增长欠佳被定义为跨越百分位数下降超过2个标准差，无论是否发展为小头畸形，小头畸形被定义为头围低于第三百分位数。
患有HIE的婴儿与对照婴儿的新生儿头围之间无统计学差异。在12个月时，48%的HIE婴儿出现小头畸形，而对照组为3%。53%的HIE婴儿记录到头围增长欠佳，而对照组为3%。头围增长欠佳与脑损伤模式显著相关，特别是与严重白质受累以及严重基底节和丘脑病变有关。与1岁时小头畸形的情况相比，头围增长欠佳预测异常神经发育结局的敏感性为79%，特异性为78%，而小头畸形的敏感性仅为65%，特异性为73%。例外情况的解释是，仅有中度白质异常的婴儿头围增长欠佳但1岁时结局正常，以及仅有中度基底节和丘脑病变的婴儿头围增长正常但有明显运动异常。
