Perinatal Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London, UK.
Lancet Neurol. 2010 Jan;9(1):39-45. doi: 10.1016/S1474-4422(09)70295-9. Epub 2009 Nov 5.
Moderate hypothermia in neonates with hypoxic-ischaemic encephalopathy might improve survival and neurological outcomes at up to 18 months of age, although complete neurological assessment at this age is difficult. To ascertain more precisely the effect of therapeutic hypothermia on neonatal cerebral injury, we assessed cerebral lesions on MRI scans of infants who participated in the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) trial.
In the TOBY trial hypoxic-ischaemic encephalopathy was graded clinically according to the changes seen on amplitude integrated EEG, and infants were randomly assigned to intensive care with or without cooling by central telephone randomisation. The relation between allocation to hypothermia or normothermia and cerebral lesions was assessed by logistic regression with perinatal factors as covariates, and adjusted odds ratios (ORs) were calculated. The TOBY trial is registered, number ISRCTN 89547571.
325 infants were recruited in the TOBY trial between 2002 and 2006. Images were available for analysis from 131 infants. Therapeutic hypothermia was associated with a reduction in lesions in the basal ganglia or thalamus (OR 0.36, 95% CI 0.15-0.84; p=0.02), white matter (0.30, 0.12-0.77; p=0.01), and abnormal posterior limb of the internal capsule (0.38, 0.17-0.85; p=0.02). Compared with non-cooled infants, cooled infants had fewer scans that were predictive of later neuromotor abnormalities (0.41, 0.18-0.91; p=0.03) and were more likely to have normal scans (2.81, 1.13-6.93; p=0.03). The accuracy of prediction by MRI of death or disability to 18 months of age was 0.84 (0.74-0.94) in the cooled group and 0.81 (0.71-0.91) in the non-cooled group.
Therapeutic hypothermia decreases brain tissue injury in infants with hypoxic-ischaemic encephalopathy. The predictive value of MRI for subsequent neurological impairment is not affected by therapeutic hypothermia.
UK Medical Research Council; UK Department of Health.
在患有缺氧缺血性脑病的新生儿中进行中度低温治疗可能会改善 18 个月时的生存和神经结局，但在这个年龄进行完整的神经评估是很困难的。为了更准确地确定治疗性低温对新生儿脑损伤的影响，我们评估了参加全身体温降低治疗新生儿脑病（TOBY）试验的婴儿的 MRI 扫描中的脑损伤。
在 TOBY 试验中，根据振幅整合脑电图上的变化对缺氧缺血性脑病进行临床分级，并通过中央电话随机分配将婴儿随机分配到强化护理组或不进行冷却。通过逻辑回归评估低温与正常体温之间的分配与脑损伤之间的关系，并作为协变量进行了围产期因素调整，计算了调整后的优势比（OR）。TOBY 试验已注册，编号 ISRCTN 89547571。
2002 年至 2006 年间，TOBY 试验共招募了 325 名婴儿。131 名婴儿的图像可供分析。治疗性低温与基底节或丘脑（OR 0.36，95%CI 0.15-0.84；p=0.02）、白质（OR 0.30，0.12-0.77；p=0.01）和异常后内囊肢（OR 0.38，0.17-0.85；p=0.02）损伤减少有关。与未冷却的婴儿相比，冷却的婴儿中较少有扫描结果预测以后的神经运动异常（0.41，0.18-0.91；p=0.03），更有可能有正常的扫描（2.81，1.13-6.93；p=0.03）。在冷却组中，MRI 预测 18 个月时死亡或残疾的准确性为 0.84（0.74-0.94），在未冷却组中为 0.81（0.71-0.91）。
治疗性低温可减少患有缺氧缺血性脑病的婴儿的脑组织损伤。MRI 对随后的神经损伤的预测价值不受治疗性低温的影响。
英国医学研究理事会；英国卫生部。
