Mathur Amit, Inder Terrie
Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
J Commun Disord. 2009 Jul-Aug;42(4):248-55. doi: 10.1016/j.jcomdis.2009.03.007. Epub 2009 Apr 7.
Preterm birth is a major public-health issue because of its increasing incidence combined with the frequent occurrence of subsequent behavioral, neurological, and psychiatric challenges faced by surviving infants. Approximately 10-15% of very preterm children (born<30 weeks gestational age) develop cerebral palsy, and 30-60% of them experience cognitive impairments. These adverse outcomes are related to a confluence of abnormal brain development along with white (WM) and gray matter (GM) injury sustained during the neonatal period. It is becoming apparent that the extra-uterine environment during this critical period (24-40 weeks gestation) in brain development has a profound and long lasting impact on the premature infant. Magnetic resonance imaging in the neonatal period and infancy provides a non-invasive, "in vivo" assessment of brain development and extent of brain injury. This not only helps understand the extent and timing of injury but also identifies infants who may benefit from early intervention to minimize the impact of the injury.
Readers will be able to (1) appreciate the diverse impact of prematurity on neurodevelopmental outcome, (2) recognize the biological vulnerability of the developing brain in premature infants born between 24 and 40 weeks of gestation, (3) understand the role of magnetic resonance imaging (MRI) as a tool to detect abnormal development and brain injury in premature infants, and (4) see the potential role for novel MR imaging methods as biomarkers for brain development and injury in premature infants.
早产是一个重大的公共卫生问题,因为其发病率不断上升,且存活婴儿随后经常面临行为、神经和精神方面的挑战。大约10%-15%的极早产儿(孕周<30周出生)会发展为脑瘫,其中30%-60%会出现认知障碍。这些不良后果与脑发育异常以及新生儿期白质(WM)和灰质(GM)损伤的共同作用有关。越来越明显的是,在脑发育的这个关键时期(孕周24-40周)的宫外环境对早产儿有深远而持久的影响。新生儿期和婴儿期的磁共振成像提供了一种非侵入性的“体内”脑发育和脑损伤程度评估。这不仅有助于了解损伤的程度和时间,还能识别可能从早期干预中受益以尽量减少损伤影响的婴儿。
读者将能够(1)认识早产对神经发育结局的多种影响,(2)认识孕周在24至40周之间出生的早产儿发育中大脑的生物学脆弱性,(3)理解磁共振成像(MRI)作为检测早产儿异常发育和脑损伤工具的作用,以及(4)了解新型磁共振成像方法作为早产儿脑发育和损伤生物标志物的潜在作用。