Stolwijk Lisanne J, Keunen Kristin, de Vries Linda S, Groenendaal Floris, van der Zee David C, van Herwaarden Maud Y A, Lemmers Petra M A, Benders Manon J N L
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Department of Brain Center Rudolf Magnus, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands; Department of Brain Center Rudolf Magnus, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
J Pediatr. 2017 Mar;182:335-341.e1. doi: 10.1016/j.jpeds.2016.11.080. Epub 2016 Dec 30.
To evaluate the incidence of brain injury after neonatal surgery for noncardiac congenital anomalies using magnetic resonance imaging (MRI).
An MRI was obtained in 101 infants at 7 days [range: 1-115] after neonatal surgery for major noncardiac congenital anomalies. Brain injury was assessed using T1, T2, diffusion weighted imaging, and susceptibility-weighted imaging.
Thirty-two preterm infants (<37 weeks of gestation) and 69 full-term infants were included. MRI abnormalities were found in 24 (75%) preterm and 40 (58%) full-term infants. Parenchymal lesions were noted in 23 preterm (72%) and 29 full-term infants (42%). These consisted of punctate white matter lesions (n = 45), punctate cerebellar lesions (n = 17), thalamic infarction (n = 5), and periventricular hemorrhagic infarction (n = 4). Nonparenchymal abnormalities were found in 9 (28%) preterm and 26 (38%) full-term infants. These included supra- and infratentorial subdural hemorrhages (n = 30), intraventricular hemorrhage grade II (n = 7), and asymptomatic sinovenous thrombosis (n = 1). A combination of parenchymal lesions was present in 21 infants. Of infants who had an MRI within 10 days after surgery, punctate white matter lesions were visible on diffusion weighted imaging in 22 (61%), suggestive of recent ischemic origin. Type of congenital anomaly and prematurity were most predictive of brain injury.
Infants who have neonatal surgery for noncardiac congenital anomalies are at risk of brain injury, potentially accounting for the neurodevelopmental delay frequently observed in this population. Further research is warranted into potential mechanisms of brain injury and its timing of onset. Long-term neurodevelopmental follow-up is needed in this vulnerable population.
使用磁共振成像（MRI）评估非心脏先天性畸形新生儿手术后脑损伤的发生率。
对101例因主要非心脏先天性畸形接受新生儿手术后7天[范围：1 - 115天]的婴儿进行了MRI检查。使用T1、T2、扩散加权成像和磁敏感加权成像评估脑损伤情况。
纳入32例早产儿（孕周<37周）和69例足月儿。24例（75%）早产儿和40例（58%）足月儿发现MRI异常。23例早产儿（72%）和29例足月儿（42%）出现实质病变。这些病变包括点状白质病变（n = 45）、点状小脑病变（n = 17）、丘脑梗死（n = 5）和脑室周围出血性梗死（n = 4）。9例（28%）早产儿和26例（38%）足月儿发现非实质异常。这些异常包括幕上和幕下硬膜下出血（n = 30）、II级脑室内出血（n = 7）和无症状静脉窦血栓形成（n = 1）。21例婴儿同时存在多种实质病变。在术后10天内进行MRI检查的婴儿中，22例（61%）在扩散加权成像上可见点状白质病变，提示近期缺血性起源。先天性畸形类型和早产对脑损伤的预测性最强。
因非心脏先天性畸形接受新生儿手术的婴儿有脑损伤风险，这可能是该人群中经常观察到的神经发育延迟的原因。有必要进一步研究脑损伤的潜在机制及其发病时间。需要对这一脆弱人群进行长期神经发育随访。
