Kinney Hannah C
Department of Pathology, Children's Hospital Boston and Harvard Medical School, MA 02115, USA.
Semin Perinatol. 2006 Apr;30(2):81-8. doi: 10.1053/j.semperi.2006.02.006.
Historically the major focus in neonatal neurology has been on brain injury in premature infants born less than 30 gestational weeks. This focus reflects the urgent need to improve the widely recognized poor neurological outcomes that occur in these infants. The most common underlying substrate of cerebral palsy in these premature infants is periventricular leukomalacia (PVL). Nevertheless, PVL also occurs in near-term (late preterm), as well as term, infants, as documented by neuroimaging and autopsy studies. In both very preterm and late preterm infants, gray matter injury is associated with PVL. In this review, we discuss the cellular pathology of PVL and the developmental parameters in oligodendrocytes and neurons that put the late preterm brain at risk in the broader context of brain development and injury close to term. Further research is needed about the clinical and pathologic aspects of brain injury in general and PVL in particular in late preterm infants to optimize management and prevent adverse neurological outcomes in these infants that, however subtle, may be currently underestimated.
从历史上看，新生儿神经学的主要关注点一直是孕周小于30周的早产儿的脑损伤。这种关注反映了迫切需要改善这些婴儿中普遍存在的不良神经学结局。这些早产儿中脑性瘫痪最常见的潜在病因是脑室周围白质软化（PVL）。然而，神经影像学和尸检研究表明，PVL也发生在近足月（晚期早产）以及足月婴儿中。在极早产儿和晚期早产儿中，灰质损伤都与PVL有关。在这篇综述中，我们在接近足月时脑发育和损伤的更广泛背景下，讨论了PVL的细胞病理学以及少突胶质细胞和神经元中的发育参数，这些参数使晚期早产脑面临风险。对于晚期早产儿脑损伤的一般临床和病理方面，尤其是PVL，需要进一步研究，以优化管理并预防这些婴儿中可能目前被低估的不良神经学结局，无论这些结局多么细微。
