Shah Divyen K, Anderson Peter J, Carlin John B, Pavlovic Masa, Howard Kelly, Thompson Deanne K, Warfield Simon K, Inder Terrie E
Victoria Infant Brain Study Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Pediatr Res. 2006 Jul;60(1):97-102. doi: 10.1203/01.pdr.0000220324.27597.f0. Epub 2006 May 11.
A substantial number of prematurely born infants will experience later neurodevelopmental challenges. Abnormal development of the cerebellum may be related to some of the impairments exhibited by preterm children. To test the hypothesis that cerebellar development is structurally impaired in preterm infants and associated with adverse outcomes, we studied 83 preterm infants and 13 term controls using volumetric magnetic resonance imaging techniques to obtain cerebellar volumes (CV) at term corrected and subsequent neurodevelopmental assessment at 2 y of age. The preterm group had smaller mean CV at term compared with the term control infants [mean (SD) CV, 22.0 (5.0) versus 23.5 (5.0) cc; mean difference (95% confidence interval), 1.5 (-1.5, 4.4)] although this did not reach statistical significance. Within the preterm group, there was evidence of a reduction in CV related to the presence of white matter injury (WMI) after adjusting for intracranial volume (ICV) [WMI grade 1 versus grade 2: mean (SD) CV, 23.6 (5.0) versus 21.6 (4.5); p = 0.01; WMI grade 1 versus grade 3 and 4: 23.6 (5.0) versus 20.8 (5.6); p = 0.07]. Within the preterm infants, there was no apparent relationship between CV at term and gestational age at birth after adjusting for ICV. At 2 y of age, CV showed a weak correlation with cognitive and motor development, although this was principally mediated by WMI. In conclusion, we found no evidence for a primary impairment in cerebellar development in relation to prematurity, although there was evidence for a secondary effect of cerebral WMI on cerebellar development independent of immaturity.
大量早产婴儿日后会面临神经发育方面的挑战。小脑发育异常可能与早产儿表现出的一些损伤有关。为了验证早产儿小脑发育存在结构损伤并与不良后果相关这一假设，我们使用容积磁共振成像技术对83名早产儿和13名足月儿对照进行了研究，以获取足月矫正时的小脑体积（CV）以及2岁时的后续神经发育评估结果。与足月儿对照婴儿相比，早产儿组在足月时的平均CV较小[平均（标准差）CV，22.0（5.0）对23.5（5.0）立方厘米；平均差异（95%置信区间），1.5（-1.5，4.4）]，尽管这未达到统计学意义。在早产儿组中，在校正颅内体积（ICV）后，有证据表明CV的减少与白质损伤（WMI）的存在有关[WMI 1级对2级：平均（标准差）CV，23.6（5.0）对21.6（4.5）；p = 0.01；WMI 1级对3级和4级：23.6（5.0）对20.8（5.6）；p = 0.07]。在早产儿中，在校正ICV后，足月时的CV与出生时的胎龄之间没有明显关系。在2岁时，CV与认知和运动发育呈弱相关，尽管这主要由WMI介导。总之，我们没有发现与早产相关的小脑发育原发性损伤的证据，尽管有证据表明脑WMI对小脑发育有独立于不成熟的继发性影响。
