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早产儿肾上腺皮质功能不全致迟发性循环功能障碍的脑部超声表现。

Brain ultrasonographic findings of late-onset circulatory dysfunction due to adrenal insufficiency in preterm infants.

机构信息

Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.

出版信息

Ultrasonography. 2016 Jul;35(3):258-64. doi: 10.14366/usg.16013. Epub 2016 Apr 18.

DOI:10.14366/usg.16013
PMID:27156563
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4939724/
Abstract

PURPOSE

The aim of this study was to characterize the brain ultrasonographic findings of late-onset circulatory dysfunction (LCD) due to adrenal insufficiency (AI) in preterm infants.

METHODS

Among the 257 preterm infants born at <33 weeks of gestation between December 2009 and February 2014 at our institution, 35 preterm infants were diagnosed with AI. Brain ultrasonographic findings were retrospectively analyzed before and after LCD in 14 preterm infants, after exclusion of the other 21 infants with AI due to the following causes: death (n=2), early AI (n=5), sepsis (n=1), and patent ductus arteriosus (n=13).

RESULTS

Fourteen of 257 infants (5.4%) were diagnosed with LCD due to AI. The age at LCD was a median of 18.5 days (range, 9 to 32 days). The last ultrasonographic findings before LCD occurred showed grade 1 periventricular echogenicity (PVE) in all 14 patients and germinal matrix hemorrhage (GMH) with focal cystic change in one patient. Ultrasonographic findings after LCD demonstrated no significant change in grade 1 PVE and no new lesions in eight (57%), grade 1 PVE with newly appearing GMH in three (21%), and increased PVE in three (21%) infants. Five infants (36%) showed new development (n=4) or increased size (n=1) of GMH. Two of three infants (14%) with increased PVE developed cystic periventricular leukomalacia (PVL) and rapid progression to macrocystic encephalomalacia.

CONCLUSION

LCD due to AI may be associated with the late development of GMH, increased PVE after LCD, and cystic PVL with rapid progression to macrocystic encephalomalacia.

摘要

目的

本研究旨在描述因肾上腺功能不全（AI）导致的早产儿晚期循环功能障碍（LCD）的脑超声表现。

方法

在我院 2009 年 12 月至 2014 年 2 月期间出生的 257 例胎龄<33 周的早产儿中，有 35 例被诊断为 AI。回顾性分析了 14 例早产儿的脑超声检查结果，这些早产儿在出现 LCD 前后均进行了检查，排除了其他 21 例因以下原因发生 AI 的早产儿：死亡（n=2）、早期 AI（n=5）、败血症（n=1）和动脉导管未闭（n=13）。

结果

257 例婴儿中有 14 例（5.4%）被诊断为因 AI 导致的 LCD。LCD 的发病年龄中位数为 18.5 天（范围 9~32 天）。LCD 前的最后一次超声检查结果显示，所有 14 例患者均有 1 级脑室周围回声增强（PVE），1 例患者伴有脑室内出血（GMH）伴局灶性囊性改变。LCD 后超声检查结果显示，8 例（57%）患者 1 级 PVE 无明显变化，无新病变；3 例（21%）患者出现 1 级 PVE 伴新出现 GMH；3 例（21%）患儿 PVE 加重。5 例（36%）患儿 GMH 出现新的发育（n=4）或增大（n=1）。3 例 PVE 加重的患儿中，有 2 例（14%）发展为囊性脑室周围白质软化（PVL），并迅速进展为巨脑性脑软化症。

结论

因 AI 导致的 LCD 可能与 GMH 的晚期发育、LCD 后 PVE 增加以及快速进展为巨脑性脑软化症的囊性 PVL 有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/691f/4939724/840ad7be9098/usg-16013-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/691f/4939724/799eb2c2cbb0/usg-16013-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/691f/4939724/8e7a468399b2/usg-16013-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/691f/4939724/840ad7be9098/usg-16013-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/691f/4939724/799eb2c2cbb0/usg-16013-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/691f/4939724/8e7a468399b2/usg-16013-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/691f/4939724/840ad7be9098/usg-16013-f3.jpg

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Hemodynamic analysis in infants with late-onset circulatory collapse.迟发性循环衰竭婴儿的血流动力学分析
Pediatr Int. 2013 Oct;55(5):582-8. doi: 10.1111/ped.12114. Epub 2013 Jul 30.
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Intracranial hemorrhage in the preterm infant: understanding it, preventing it.早产儿颅内出血：了解它，预防它。
Clin Perinatol. 2009 Dec;36(4):737-62, v. doi: 10.1016/j.clp.2009.07.014.
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Comparison of serum cortisol concentrations in preterm infants with or without late-onset circulatory collapse due to adrenal insufficiency of prematurity.因早产肾上腺功能不全导致或未导致迟发性循环衰竭的早产儿血清皮质醇浓度比较。
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