Hayes Breda C, Ryan Stephanie, McGarvey Cliona, Mulvany Siobhan, Doherty Elaine, Grehan Andrea, Madigan Cathy, Matthews Tom, King Mary D
a Rotunda Maternity Hospital , Dublin , Ireland .
b The Children's University Hospital , Dublin , Ireland , and.
J Matern Fetal Neonatal Med. 2016 Mar;29(5):777-82. doi: 10.3109/14767058.2015.1018167. Epub 2015 Sep 4.
To correlate pattern of injury on neonatal brain magnetic resonance imaging (MRI) with outcome in infants ≥36 + 0 weeks gestation with hypoxic ischaemic encephalopathy.
Prospective cohort study. Images were blindly reviewed. Children were assessed using a variety of standardised assessments.
MRI brain was performed on 88 infants. Follow up was available in 73(83%) infants. Eight of 25(32%) children with normal imaging had below normal assessment scores. Eight infants (12%) had isolated punctate white matter lesions and five of these had abnormal assessment scores. Death and cerebral palsy were seen only in children with imaging scores ≥3 on basal ganglia/thalami (BGT) score or ≥4 on watershed score. No developmental concerns were raised in 3/7(43%) infants with isolated watershed injury. Ten of 13(77%) infants with isolated BGT injury died or developed cerebral palsy. All 23 children with posterior limb of the internal capsule (PLIC) injury displayed developmental difficulties.
Almost one-third of infants with a normal MRI brain may be at risk of developmental problems. Punctate foci of white matter injury are common and not always benign. PLIC involvement is usually associated with neurological sequelae including isolated cognitive deficits. Worst outcomes are associated with basal ganglia injury.
将新生儿脑磁共振成像（MRI）的损伤模式与孕周≥36+0周的缺氧缺血性脑病婴儿的预后相关联。
前瞻性队列研究。对图像进行盲法评估。使用多种标准化评估方法对儿童进行评估。
对88名婴儿进行了脑部MRI检查。73名（83%）婴儿获得了随访结果。25名（32%）影像学正常的儿童中有8名评估分数低于正常水平。8名婴儿（12%）有孤立的点状白质病变，其中5名评估分数异常。仅在基底节/丘脑（BGT）评分为≥3分或分水岭评分为≥4分的儿童中出现死亡和脑瘫。3/7（43%）有孤立分水岭损伤的婴儿未出现发育问题。13名（77%）有孤立BGT损伤的婴儿中有10名死亡或发展为脑瘫。所有23名内囊后肢（PLIC）损伤的儿童均出现发育困难。
MRI脑部正常的婴儿中近三分之一可能有发育问题的风险。点状白质损伤灶很常见，且并非总是良性的。PLIC受累通常与包括孤立认知缺陷在内的神经后遗症相关。最差的预后与基底节损伤有关。
