Wang Ying-Jie, Mao Jian
Department of Neonatology, Shengjing Hospital, China Medical University, Shenyang 110004, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2014 Jun;16(6):589-95.
To investigate the clinical and imaging characteristics of acute hypoxic-ischemic brain injury (HIBI) due to perinatal sentinel events in neonates.
Forty-six neonates with acute HIBI who were admitted between January 2004 and May 2013, and who had a history of major cardiopulmonary resuscitation, were enrolled in the study. They were classified into full-term and preterm infants to analyze the clinical and imaging characteristics.
Among full-term infants, the incidence rates of white matter injury, cortical injury, basal ganglia /thalamic injury, and brain stem injury were 95%, 90%, 75%, and 65%, respectively; among preterm infants, the incidence rates of white matter injury, cortical injury, basal ganglia/thalamic injury, and brain stem injury were 73%, 23%, 19%, and 15%, respectively. Compared with full-term infants, preterm infants had a significantly lower incidence of gray matter injury in the cortex, basal ganglia/thalamus, and brain stem (P<0.05). About 46% of all subjects had multiple organ dysfunction. The 20 full-term infants with HIBI had typical clinical manifestations; 19 (95%) of them had moderate or severe neonatal encephalopathy, with mixed lesions on magnetic resonance imaging (MRI), and moderate or severe basal ganglia/thalamic injury was found in 68% of these patients. Multiple organ dysfunction, various abnormal neurological manifestations, and arterial blood pH less than 7.1 were closely related to moderate or severe brain injury.
White matter injury is the most common type of HIBI. Gray matter injury can be found in preterm infants, but the incidence is lower than that in full-term infants. Moderate or severe neonatal encephalopathy is mainly manifested as basal ganglia/thalamic injury on MRI. Evaluation of multiple organ dysfunction and abnormal neurological manifestations and early blood gas analysis are very important for the diagnosis of neonatal HIBI.
探讨新生儿围产期哨兵事件所致急性缺氧缺血性脑损伤（HIBI）的临床及影像学特征。
选取2004年1月至2013年5月收治的46例急性HIBI新生儿，这些新生儿均有主要心肺复苏史，将其分为足月儿和早产儿，分析其临床及影像学特征。
足月儿中，白质损伤、皮质损伤、基底节/丘脑损伤及脑干损伤的发生率分别为95%、90%、75%和65%；早产儿中，白质损伤、皮质损伤、基底节/丘脑损伤及脑干损伤的发生率分别为73%、23%、19%和15%。与足月儿相比，早产儿皮质、基底节/丘脑及脑干灰质损伤的发生率显著更低（P<0.05）。约46%的所有受试者存在多器官功能障碍。20例足月儿HIBI有典型临床表现；其中19例（95%）有中度或重度新生儿脑病，磁共振成像（MRI）显示混合性病变，68%的这些患者存在中度或重度基底节/丘脑损伤。多器官功能障碍、各种异常神经表现及动脉血pH值小于7.1与中度或重度脑损伤密切相关。
白质损伤是HIBI最常见的类型。早产儿可出现灰质损伤，但发生率低于足月儿。中度或重度新生儿脑病在MRI上主要表现为基底节/丘脑损伤。评估多器官功能障碍和异常神经表现以及早期血气分析对新生儿HIBI的诊断非常重要。
