Ricci D, Guzzetta A, Cowan F, Haataja L, Rutherford M, Dubowitz L, Mercuri E
Department of Paediatrics, Faculty of Medicine, Imperial College, Hammersmith Campus, London, United Kingdom.
Neuropediatrics. 2006 Jun;37(3):148-53. doi: 10.1055/s-2006-924333.
The aims of this study were to (a) describe the evolution of neurological signs after the neonatal period in infants with neonatal encephalopathy and abnormal outcome and (b) to establish the relationship between the evolution of neurological signs and patterns of lesions on brain MRI.
Fifteen children with low Apgar scores, abnormal neurological signs at the end of the neonatal period, and abnormal outcome were examined at 1 - 2 weeks, 5 - 7 weeks, and 6 months. All the infants had at least one MRI scan performed in the neonatal period.
All infants had persistent abnormalities on all examinations performed but the severity of neurological impairment was variable and was related to the pattern of brain lesions. Infants with severe basal ganglia and white matter lesions showed abnormal axial and limb tone, movements, and visual function on all the examinations and none achieved independent sitting. In infants with moderate basal ganglia lesions and/or severe white matter changes, visual function and feeding improved by 5 - 7 weeks and were still normal at 6 months while limb tone, which was reduced in the first weeks, appeared to be normal at 5 - 6 weeks but was found to be increased at 6 months; all were able to sit unsupported at 2 years and most of them achieved the ability to walk with support.
Our results suggest that the evolution of the neurological patterns after the neonatal period in infants with persisting neonatal abnormalities depends on their pattern of brain lesions.
本研究的目的是(a)描述患有新生儿脑病且预后异常的婴儿在新生儿期后神经体征的演变情况，以及(b)确定神经体征演变与脑部磁共振成像（MRI）病变模式之间的关系。
对15名阿氏评分低、在新生儿期末期神经体征异常且预后异常的儿童在1 - 2周、5 - 7周和6个月时进行了检查。所有婴儿在新生儿期至少进行了一次MRI扫描。
所有婴儿在所有检查中均有持续性异常，但神经损伤的严重程度各不相同，且与脑损伤模式有关。患有严重基底神经节和白质病变的婴儿在所有检查中均表现出轴向和肢体肌张力、运动及视觉功能异常，且无一能独立坐立。患有中度基底神经节病变和/或严重白质改变的婴儿，其视觉功能和喂养情况在5 - 7周时有所改善，6个月时仍正常，而肢体肌张力在最初几周降低，在5 - 6周时看似正常，但在6个月时发现升高；所有婴儿在2岁时均能独立坐立，其中大多数在有支撑的情况下能够行走。
我们的结果表明，患有持续性新生儿异常的婴儿在新生儿期后神经模式的演变取决于其脑损伤模式。
