Barnett A, Mercuri E, Rutherford M, Haataja L, Frisone M F, Henderson S, Cowan F, Dubowitz L
Department of Paediatrics, Imperial College School of Medicine, Hammersmith Campus, London, United Kingdom.
Neuropediatrics. 2002 Oct;33(5):242-8. doi: 10.1055/s-2002-36737.
The aims of this study were 1) to determine the incidence of minor neurological dysfunction and perceptual-motor difficulties in children aged 5-1/2 -- 6-1/2, who had been born full-term but presented with neonatal encephalopathy (NE) and low Apgar scores and 2) to examine the relationships between the presence/absence of these difficulties with neonatal brain MRI.
Sixty-eight full-term infants with one minute Apgar scores less than or equal to 5 and neurological abnormalities during the first 48 hours after birth were included in the study. All children had a neonatal MRI brain scan. Surviving infants were assessed between the age of 5 and 6 years using the Touwen Examination, the Movement ABC and the WPPSI-R.
Fifteen of the 68 infants (22 %) died in the neonatal period. Of the 53 surviving infants, 19 (36 %) had cerebral palsy. The remaining 34 were considered normal at 2 years of age but, when assessed at school age, 8 (15 %) had minor neurological dysfunction and/or perceptual-motor difficulties, 1 (2 %) had only cognitive impairment and 25 (47 %) were normal. The outcome largely reflected the pattern of lesions on brain imaging. While 83 % of those with a normal outcome had normal scans or minimal white matter lesions, 80 % of those with minor neurological dysfunction and/or perceptual-motor difficulties had mild or moderate basal ganglia or more marked white matter lesions.
Continued surveillance is recommended for children with apparently normal outcome at two years of age after NE, particularly when abnormalities are detected on brain MRI.
本研究的目的是：1）确定足月出生但患有新生儿脑病（NE）且阿氏评分低的5岁半至6岁半儿童中轻度神经功能障碍和感知运动困难的发生率；2）研究这些困难的有无与新生儿脑部磁共振成像（MRI）之间的关系。
本研究纳入了68名足月出生、出生后1分钟阿氏评分小于或等于5且出生后48小时内有神经异常的婴儿。所有儿童均进行了新生儿脑部MRI扫描。存活的婴儿在5至6岁时使用图温检查、运动ABC量表和韦氏幼儿智力量表修订版（WPPSI-R）进行评估。
68名婴儿中有15名（22%）在新生儿期死亡。在53名存活的婴儿中，19名（36%）患有脑瘫。其余34名在2岁时被认为正常，但在学龄期评估时，8名（15%）有轻度神经功能障碍和/或感知运动困难，1名（2%）仅有认知障碍，25名（47%）正常。结果在很大程度上反映了脑成像上的病变模式。虽然83%结局正常的婴儿扫描结果正常或仅有轻微白质病变，但80%有轻度神经功能障碍和/或感知运动困难的婴儿有轻度或中度基底节病变或更明显的白质病变。
建议对新生儿脑病后2岁时结局明显正常的儿童进行持续监测，尤其是在脑部MRI检查发现异常时。
