Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Pediatr Neurol. 2013 Feb;48(2):123-129.e1. doi: 10.1016/j.pediatrneurol.2012.10.016.
Premature infants are at risk for adverse motor outcomes, including cerebral palsy and developmental coordination disorder. The purpose of this study was to examine the relationship of antenatal, perinatal, and postnatal risk factors for abnormal development of the corticospinal tract, the major voluntary motor pathway, during the neonatal period. In a prospective cohort study, 126 premature neonates (24-32 weeks' gestational age) underwent serial brain imaging near birth and at term-equivalent age. With diffusion tensor tractography, mean diffusivity and fractional anisotropy of the corticospinal tract were measured to reflect microstructural development. Generalized estimating equation models examined associations of risk factors on corticospinal tract development. The perinatal risk factor of greater early illness severity (as measured by the Score for Neonatal Acute Physiology-II [SNAP-II]) was associated with a slower rise in fractional anisotropy of the corticospinal tract (P = 0.02), even after correcting for gestational age at birth and postnatal risk factors (P = 0.009). Consistent with previous findings, neonatal pain adjusted for morphine and postnatal infection were also associated with a slower rise in fractional anisotropy of the corticospinal tract (P = 0.03 and 0.02, respectively). Lessening illness severity in the first hours of life might offer potential to improve motor pathway development in premature newborns.
早产儿有发生不良运动结果的风险，包括脑瘫和发育性协调障碍。本研究的目的是探讨围产期和产后危险因素与新生儿期皮质脊髓束（主要的自主运动通路）发育异常的关系。在一项前瞻性队列研究中，126 名早产儿（24-32 周胎龄）在接近出生时和足月时进行了一系列脑部成像。通过弥散张量追踪技术，测量皮质脊髓束的平均弥散度和各向异性分数，以反映其微观结构发育。广义估计方程模型检验了危险因素与皮质脊髓束发育的关系。早期疾病严重程度较高（通过新生儿急性生理学评分-Ⅱ[SNAP-Ⅱ]评估）的围产期危险因素与皮质脊髓束各向异性分数的上升速度较慢有关（P=0.02），即使在校正了出生时的胎龄和产后危险因素后（P=0.009）也是如此。与先前的发现一致，调整吗啡和产后感染的新生儿疼痛也与皮质脊髓束各向异性分数上升速度较慢有关（分别为 P=0.03 和 0.02）。减轻生命最初数小时的疾病严重程度可能为改善早产儿运动通路发育提供了潜力。
