Loureiro Begoña, Martinez-Biarge Miriam, Foti Francesca, Papadaki Maria, Cowan Frances M, Wusthoff Courtney J
Departamento de Pediatría, Hospital Universitario Cruces, Barakaldo, Spain.
Department of Paediatrics, Hammersmith Hospital, Imperial College, London, UK.
Early Hum Dev. 2017 Feb;105:17-22. doi: 10.1016/j.earlhumdev.2017.01.001. Epub 2017 Jan 17.
To define patterns of brain injury and associated neurodevelopmental outcomes in infants with severe neonatal anaemia.
We studied 20 infants with severe anaemia at birth (haemoglobin<7g/dL). Clinical details were analysed for causes of anaemia and co-morbidities. All had early brain magnetic resonance imaging (MRI) scans, which were reviewed for injury pattern. Neurodevelopmental outcomes were assessed at a median age of 24months.
The aetiology of the anaemia was feto-maternal haemorrhage in 17 and antepartum haemorrhage in 3 infants. The predominant site of injury was the white matter, which was affected in all infants, with differing grades of severity and with cystic evolution in 45%. Only one infant showed an injury pattern typical of an acute severe hypoxic-ischaemic insult. Outcomes correlated closely to the severity of MRI findings. Cerebral palsy was seen only with the most severe neuroimaging patterns (n=6). Global developmental delay, learning or behavioural problems and seizures were common with moderate injury. Visual impairment occurred, particularly with posterior injury. Microcephaly developed in 45%.
Severe neonatal anaemia at birth was associated with a white matter predominant pattern of injury, the severity of which was related to neurodevelopmental outcomes. Early MRI and long-term follow-up are advisable following severe neonatal anaemia.
明确重症新生儿贫血患儿的脑损伤模式及相关神经发育结局。
我们研究了20例出生时患有重症贫血（血红蛋白<7g/dL）的婴儿。分析临床细节以找出贫血病因及合并症。所有患儿均接受了早期脑磁共振成像（MRI）扫描，并对损伤模式进行评估。在中位年龄24个月时评估神经发育结局。
贫血病因中，17例为胎儿-母体出血，3例为产前出血。主要损伤部位是白质，所有婴儿均受影响，严重程度各异，45%出现囊性演变。仅1例婴儿表现出典型的急性重度缺氧缺血性损伤模式。结局与MRI检查结果的严重程度密切相关。仅在最严重的神经影像学模式下出现脑性瘫痪（n = 6）。中度损伤时常见全面发育迟缓、学习或行为问题以及癫痫发作。出现视力障碍，尤其是后部损伤时。45%出现小头畸形。
出生时的重症新生儿贫血与以白质为主的损伤模式相关，其严重程度与神经发育结局有关。重症新生儿贫血后建议早期进行MRI检查及长期随访。
