Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht 3508 AB, The Netherlands.
Ultrasound Obstet Gynecol. 2009 Sep;34(3):253-8. doi: 10.1002/uog.6423.
To determine which prenatal ultrasound findings can predict survival and mental and motor functioning in children with spina bifida.
Prenatal ultrasound examinations of all liveborn children who were prenatally diagnosed with spina bifida between 1997 and 2002 at the University Medical Centre, Utrecht (n = 41) were retrospectively reviewed for lesion level, head circumference, ventriculomegaly, scoliosis and talipes. These measures were correlated with postnatal anatomical (as assessed by magnetic resonance imaging (MRI)) and functional lesion levels, survival and motor and mental outcome at 5 years of age. The capacity of prenatal ultrasonography to determine lesion level was also assessed in all fetuses diagnosed with spina bifida from 2006-2007 (n = 18).
Nineteen infants died before the age of 5 years. Multivariate regression analysis showed that higher lesion level and head circumference > or = the 90th percentile on prenatal ultrasound examination were independent predictors of demise (P < 0.05 and P = 0.01, respectively). None of the ultrasound features was a predictor of motor or mental functioning. Ultrasound predicted anatomical lesion level within one level of the postnatal findings in 50% of the first cohort and 89% of the second cohort (P < 0.01). The level of the anatomical lesion as assessed by postnatal MRI differed from the functional lesion by as many as six vertebral levels.
Lesion level and head circumference on prenatal ultrasound are predictive of survival in children with spina bifida. No predictors were found for mental or motor function at the age of 5 years.
确定产前超声检查结果中哪些可以预测脊柱裂患儿的生存和精神运动功能。
回顾性分析了 1997 年至 2002 年在乌得勒支大学医学中心（University Medical Centre, Utrecht）出生并被产前诊断为脊柱裂的所有活产儿（n = 41）的产前超声检查结果，包括病变水平、头围、脑室扩大、脊柱侧凸和马蹄内翻足。将这些指标与出生后的解剖学（由磁共振成像（Magnetic Resonance Imaging, MRI）评估）和功能病变水平、生存率以及 5 岁时的运动和精神发育情况进行了相关性分析。还评估了 2006-2007 年（n = 18）所有诊断为脊柱裂的胎儿的产前超声检查对病变水平的确定能力。
19 名婴儿在 5 岁前死亡。多变量回归分析显示，较高的病变水平和产前超声检查头围> =第 90 百分位数是死亡的独立预测因素（P < 0.05 和 P = 0.01）。超声特征均不能预测运动或精神功能。在第一组中，超声检查在 50%的病例中预测到与产后发现相差 1 个水平的解剖病变水平，在第二组中预测到 89%的病例（P < 0.01）。产后 MRI 评估的解剖病变水平与功能病变水平相差多达 6 个椎体水平。
产前超声检查的病变水平和头围可预测脊柱裂患儿的生存率。在 5 岁时，没有发现可预测精神或运动功能的指标。
