Department of Pediatrics, University of California, San Francisco, California; Department of Neurology, University of California, San Francisco, California; Department of Pediatrics, University of British Columbia, Vancouver, Canada.
Pediatr Neurol. 2013 Dec;49(6):401-5. doi: 10.1016/j.pediatrneurol.2013.08.007. Epub 2013 Oct 2.
To evaluate the predominant pattern of brain injury and the anatomic areas of injury in children with infantile spasms following neonatal hypoxic-ischemic encephalopathy.
A nested case-control study of infantile spasms in children with term neonatal hypoxic-ischemic encephalopathy was performed. All patients had T1/T2-weighted magnetic resonance imaging with diffusion-weighted imaging performed on the third day of life. Using a validated scoring system, the magnetic resonance imaging was classified as: normal, watershed, basal ganglia/thalamus, total, or focal-multifocal. Two study investigators scored additional anatomic areas of injury (cortical extent, levels of the brainstem, hypothalamus) on T1/T2-weighted magnetic resonance imaging and diffusion-weighted imaging blinded to the outcome. The predominant pattern of brain injury and anatomic areas of injury were compared between patients who developed infantile spasms and randomly selected controls.
Eight patients who developed infantile spasms were identified among a cohort of 176 term newborns with hypoxic-ischemic encephalopathy (4.5%). There were no significant differences in the perinatal and neonatal course between newborns who developed infantile spasms and controls who did not. The development of infantile spasms after neonatal hypoxic-ischemic encephalopathy was significantly associated with basal ganglia/thalamus and total brain injury (P = 0.001), extent of cortical injury greater than 50% (odds ratio = 11.7, 95% confidence interval = 1.1-158.5, P = 0.01), injury to the midbrain (odds ratio = 13, 95% confidence interval = 1.3-172, P = 0.007) and hypothalamic abnormalities (P = 0.01).
The development of infantile spasms after hypoxic-ischemic encephalopathy is associated with injury to the basal ganglia and thalami on neonatal magnetic resonance imaging, particularly when extensive cortical injury and/or injury to the midbrain is present.
评估新生儿缺氧缺血性脑病后婴儿痉挛的主要脑损伤模式和损伤部位。
对伴有足月新生儿缺氧缺血性脑病的婴儿痉挛进行了嵌套病例对照研究。所有患者在出生后第 3 天行 T1/T2 加权磁共振成像和弥散加权成像。使用经过验证的评分系统，磁共振成像分为正常、分水岭、基底节/丘脑、全脑或局灶性多灶性。两名研究人员在 T1/T2 加权磁共振成像和弥散加权成像上对皮质范围、脑桥水平、下丘脑等额外的损伤部位进行评分，评分时对结局不知情。比较了发生婴儿痉挛的患者与随机选择的对照组之间的主要脑损伤模式和损伤部位。
在 176 例伴有缺氧缺血性脑病的足月新生儿队列中发现了 8 例发生婴儿痉挛的患者（4.5%）。发生婴儿痉挛的新生儿与未发生婴儿痉挛的对照组之间的围产期和新生儿期病程无显著差异。新生儿缺氧缺血性脑病后发生婴儿痉挛与基底节/丘脑和全脑损伤显著相关（P = 0.001），皮质损伤程度大于 50%（优势比=11.7，95%置信区间=1.1-158.5，P = 0.01），中脑损伤（优势比=13，95%置信区间=1.3-172，P = 0.007）和下丘脑异常（P = 0.01）。
缺氧缺血性脑病后婴儿痉挛的发生与新生儿磁共振成像上基底节和丘脑损伤有关，尤其是当存在广泛的皮质损伤和/或中脑损伤时。
